Co-manipulation surgical system having actuatable setup joints

ABSTRACT

Co-manipulation robotic systems are described herein that may be used for assisting with laparoscopic surgical procedures. The co-manipulation robotic systems allow a surgeon to use commercially-available surgical tools while providing benefits associated with surgical robotics. Advantageously, the surgical tools may be seamlessly coupled to the robot arms using a disposable coupler while the reusable portions of the robot arm remain in a sterile drape. Further, the co-manipulation robotic system may operate in multiple modes to enhance usability and safety, while allowing the surgeon to position the instrument directly with the instrument handle and further maintain the desired position of the instrument using the robot arm.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part application of U.S. patentapplication Ser. No. 18/057,191, filed Nov. 18, 2022, which is acontinuation-in-part application of U.S. patent application Ser. No.17/815,885, filed Jul. 28, 2022, now U.S. Pat. No. 11,504,197, which isa continuation application of PCT Patent Appl. No. PCT/IB2022/052989,filed Mar. 30, 2022, and claims priority to U.S. Provisional PatentAppl. No. 63/378,434, filed Oct. 5, 2022, EP Patent Appl. No.22306496.5, filed Oct. 5, 2022, EP Patent Appl. No. 21306904.0, filedDec. 22, 2021, EP Patent Appl. No. 21306905.7, filed Dec. 22, 2021, EPPatent Appl. No. 21305929.8, filed Jul. 5, 2021, and EP Patent Appl. No.21305417.4, filed Mar. 31, 2021, the entire contents of each of whichare incorporated herein by reference. This application also claims thebenefit of priority of U.S. Provisional Patent Appl. No. 63/495,527,filed Apr. 11, 2023, U.S. Provisional Patent Appl. No. 63/479,142, filedJan. 9, 2023, and EP Patent Appl. No. 23305026.9, filed Jan. 9, 2023,the entire contents of each of which are incorporated herein byreference.

FIELD OF USE

This technology relates to co-manipulation robotic systems, such asthose designed to be coupled to clinician-selected surgical instrumentsto permit movement of the robot arm(s) via movement at the handle of thesurgical instrument(s), along with enhanced features for setup andautomatic intraoperative movements.

BACKGROUND

Managing vision and access during a laparoscopic procedure is achallenge. The surgical assistant paradigm is inherently imperfect, asthe assistant is being asked to anticipate and see with the surgeon'seyes, without standing where the surgeon stands, and similarly toanticipate and adjust how the surgeon wants the tissue of interestexposed, throughout the procedure. For example, during a laparoscopicprocedure, one assistant may be required to hold a retractor device toexpose tissue for the surgeon, while another assistant may be requiredto hold a laparoscope device to provide a field of view of the surgicalspace within the patient to the surgeon during the procedure, either oneof which may be required to hold the respective tools in an impracticalposition, e.g., from between the arms of the surgeon while the surgeonis actively operating additional surgical instruments.

Various attempts have been made at solving this issue. For example, arail-mounted orthopedic retractor, which is a purely mechanical devicethat is mounted to the patient bed/table, may be used to hold alaparoscope device in position during a laparoscopic procedure, andanother rail-mounted orthopedic retractor may be used to hold aretractor device in position during the laparoscopic procedure. However,the rail-mounted orthopedic retractor requires extensive manualinteraction to unlock, reposition, and lock the tool in position.

Complex robot-assisted systems such as the Da Vinci Surgical System(made available by Intuitive Surgical, Sunnyvale, California) have beenused by surgeons to enhance laparoscopic surgical procedures bypermitting the surgeon to tele-operatively perform the procedure from asurgeon console remote from the patient console holding the surgicalinstruments. Such complex robot-assisted systems are very expensive, andhave a very large footprint and take up a lot of space in the operatingroom. Moreover, such robot-assisted systems typically require uniquesystem-specific surgical instruments that are compatible with thesystem, and thus surgeons may not use standard off-the-shelf surgicalinstruments that they are used to. As such, the surgeon is required tolearn an entirely different way of performing the laparoscopicprocedure.

In view of the foregoing drawbacks of previously known systems andmethods, there exists a need for a system that provides the surgeon withthe ability to seamlessly position and manipulate various surgicalinstruments as needed, thus avoiding the workflow limitations inherentto both human and mechanical solutions.

SUMMARY

The present disclosure overcomes the drawbacks of previously-knownsystems and methods by providing a co-manipulation surgical system toassist with laparoscopic surgery performed using a surgical instrumenthaving a handle, an operating end, and an elongated shaft therebetween.The co-manipulation surgical system may include a robot arm having aproximal end, a distal end that may be removably coupled to the surgicalinstrument, a plurality of links, and a plurality of joints between theproximal end and the distal end. The co-manipulation surgical systemfurther may include a controller operatively coupled the robot arm. Thecontroller may be programmed to cause the robot arm to automaticallyswitch between: a passive mode responsive to determining that movementof the robot arm due to movement at the handle of the surgicalinstrument is less than a predetermined amount for at least apredetermined dwell time period, wherein the controller may beprogrammed to cause the robot arm to maintain a static position in thepassive mode; and a co-manipulation mode responsive to determining thatforce applied at the robot arm due to force applied at the handle of thesurgical instrument exceeds a predetermined threshold, wherein thecontroller may be programmed to permit the robot arm to be freelymoveable in the co-manipulation mode responsive to movement at thehandle of the surgical instrument for performing laparoscopic surgeryusing the surgical instrument, and wherein the controller may beprogrammed to apply a first impedance to the robot arm in theco-manipulation mode to account for weight of the surgical instrumentand the robot arm. The controller further may be programmed to cause therobot arm to automatically switch to a haptic mode responsive todetermining that at least a portion of the robot arm is outside apredefined haptic barrier, wherein the controller may be programmed toapply a second impedance to the robot arm in the haptic mode greaterthan the first impedance, thereby making movement of the robot armresponsive to movement at the handle of the surgical instrument moreviscous in the haptic mode than in the co-manipulation mode.

In accordance with one aspect of the present disclosure, aco-manipulation surgical system to assist with laparoscopic surgeryperformed using a surgical instrument having a handle, an operating end,and an elongated shaft therebetween is provided. The co-manipulationsurgical system may include a robot arm comprising a proximal end, adistal end configured to be removably coupled to the surgicalinstrument, a plurality of links, and a plurality of joints between theproximal end and the distal end, and a controller operatively coupled tothe robot arm and configured to permit the robot arm to be freelymoveable responsive to movement at the handle of the surgical instrumentfor performing laparoscopic surgery. The controller programmed to: causethe robot arm to maintain a static position in a passive mode responsiveto determining that movement of the robot arm due to movement at thehandle of the surgical instrument is less than a predetermined amountfor at least a predetermined dwell time period; identify, when thesurgical instrument comprises a laparoscope having a field of view, atarget surgical instrument within the field of view of the laparoscopebased on image data from the laparoscope; and cause the robot arm toswitch to an instrument centering mode where the robot arm moves thelaparoscope to maintain the target surgical instrument within the fieldof view of the laparoscope.

The controller may be configured to cause the robot arm to automaticallyswitch to a co-manipulation mode responsive to determining that forceapplied at the robot arm due to force applied at the handle of thesurgical instrument exceeds a predetermined threshold. Accordingly, thecontroller may be configured to permit the robot arm to be freelymoveable in the co-manipulation mode responsive to movement at thehandle of the surgical instrument, while applying an impedance to therobot arm in the co-manipulation mode to account for weight of thesurgical instrument and the robot arm. In addition, the controller maybe configured to identify the target surgical instrument within thefield of view of the laparoscope by detecting a predefined gesturalpattern by the target surgical instrument within the field of view ofthe laparoscope. The predefined gestural pattern may comprisepositioning of the target surgical instrument within a center portion ofthe field of view of the laparoscope and maintaining the position of thetarget surgical instrument within the center portion for at least apredetermined hold period. In some embodiments, the controller may beconfigured to identify the target surgical instrument within the fieldof view of the laparoscope based on user input identifying the targetsurgical instrument. Moreover, the controller may be configured todistinguish the target surgical instrument from one or more othersurgical instruments within the field of view of the laparoscope. In theinstrument centering mode, the controller may cause the robot arm tomove the laparoscope to maintain the target surgical instrument within apredefined boundary region within the field of view of the laparoscope,such that the robot arm does not move the laparoscope unless the targetsurgical instrument moves outside of the predefined boundary region.

Moreover, in the instrument centering mode, the controller may cause therobot arm to move the laparoscope by executing a trajectory generationalgorithm to generate a trajectory from a current position of thelaparoscope to a desired position of the laparoscope, and causing therobot arm to move the laparoscope along the trajectory to maintain thetarget surgical instrument within the field of view of the laparo scope.Accordingly, the controller may be configured to: permit the robot armto be freely moveable in a co-manipulation mode responsive todetermining that force applied at the robot arm due to force applied atthe laparoscope exceeds a predetermined threshold, while applying animpedance to the robot arm in the co-manipulation mode to account forweight of the laparoscope and the robot arm; record a trajectory of thefreely moving robot arm when the movement of the robot arm deviates fromthe generated trajectory; and update the trajectory generation algorithmbased the recorded trajectory. The generated trajectory may comprisemoving the robot arm along a longitudinal axis of the laparoscope tomaintain the target surgical instrument within the field of view of thelaparoscope and within a predetermined resolution threshold. Inaddition, the generated trajectory may comprise moving the robot armalong at least one of a longitudinal axis of the laparoscope or an axisperpendicular to the longitudinal axis of the laparoscope to maintainthe target surgical instrument within the field of view of thelaparoscope.

The trajectory may be generated by: measuring a current position of thedistal end of the robot arm; determining a point of entry of thelaparoscope into the patient; and calculating a distance required tomove the distal end of the robot arm from its current position to asecond position that causes a distal end of the laparoscope to move fromits current position to the desired position based on the point of entryand a known length between the distal end of the robot arm and thedistal end of the laparoscope. The controller may cause the robot arm tomove the laparoscope along the trajectory by: calculating a forcerequired to move the distal end of the robot arm the distance from itscurrent position to the second position; and applying torque to the atleast some joints of the plurality of joints of the robot arm based onthe calculated force to move the distal end of the robot arm thedistance from its current position to the second position to therebymove the distal end of the laparoscope from its current position to thedesired position. Further, the controller may be configured to: detectan offset angle between a camera head of the laparoscope and thelaparoscope; and calibrate the trajectory to correct the offset anglesuch that movement of the laparoscope along the calibrated trajectorymaintains the target surgical instrument within the field of view of thelaparoscope. For example, the controller may be configured to detect theoffset angle by: causing the robot arm to move along a predeterminedtrajectory in a known direction in a robot arm coordinate frame;measuring an actual movement of a static object within the field of viewof the laparoscope responsive to movement of the robot arm along thepredetermined trajectory; and comparing the actual movement of thestatic object with an expected movement of the static object associatedwith the predetermined trajectory.

The controller further may be configured to cause the robot arm toswitch to the instrument centering mode responsive to user input. Inaddition, the controller may be configured to: determine a phase of thelaparoscopic surgery; estimate the target surgical instrument based onthe phase of the laparoscopic surgery; and identify the target surgicalinstrument within the field of view of the laparoscope based on theestimation and the image data from the laparoscope. Moreover, thecontroller may be configured to: determine a phase of the laparoscopicsurgery; and automatically switch to the instrument centering moderesponsive to the phase of the laparoscopic surgery. Accordingly, thecontroller may be configured to: identify one or more anatomicalstructures within the field of view of the laparoscope based on imagedata from the laparoscope; determine the phase of the laparoscopesurgery based on the identified one or more anatomical structures; andcause the robot arm, in the instrument centering mode, to move thelaparoscope to maintain the identified one or more anatomical structureswithin the field of view of the laparoscope. Additionally, thecontroller may be configured to: generate an overlay indicative of thetarget surgical instrument; and cause the overlay to be displayed overthe image data from the laparoscope via a graphical user interface.

The controller may be configured to: cause the robot arm to move thelaparoscope in a predetermined trajectory; and compare an actualtrajectory of the image data from the laparoscope during movement alongthe predetermined trajectory with an expected trajectory of the imagedata associated with the predetermined trajectory to determine an angleof a distal tip of the laparoscope. For example, the predeterminedtrajectory may comprise a circular pattern in a single plane. Moreover,the controller may be configured to identify the target surgicalinstrument within the field of view of the laparoscope based on imagedata from the laparoscope using machine learning algorithms executed atthe controller. For example, the machine learning algorithms may betrained with a database of annotated image data of associated surgicalinstruments. Accordingly, the machine learning algorithms may beconfigured to evaluate pixels of the image data from the laparoscope andindicate if the pixels correspond to the target surgical instrument toidentify the target surgical instrument. The controller may beconfigured to identify the target surgical instrument within the fieldof view of the laparoscope in real time. The controller may beconfigured to cause, in the instrument centering mode, the robot arm tomove the laparoscope to track the target surgical instrument that isbeing manually held by a surgeon. In some embodiments, the system mayinclude a second robot arm configured to be removably coupled to thetarget surgical instrument that is being manually held by the surgeon.

In accordance with another aspect of the present disclosure, a methodfor assisting with laparoscopic surgery is provided. The method mayinclude: providing a robot arm comprising a proximal end, a distal endconfigured to be removably coupled a laparoscope, a plurality of links,and a plurality of joints between the proximal end and the distal end;permitting, via a controller operatively coupled to the robot arm, therobot arm to be freely moveable responsive to movement at the handle ofthe laparoscope for performing laparoscopic surgery; automaticallycausing, via the controller, the robot arm to maintain a static positionin a passive mode responsive to determining that movement of the robotarm due to movement at the handle of the laparoscope is less than apredetermined amount for at least a predetermined dwell time period;identifying, via the controller, a target surgical instrument within afield of view of the laparoscope based on image data from thelaparoscope; switching, via the controller, the robot arm to aninstrument centering mode; and automatically causing, via the controllerwhile in the instrument centering mode, the robot arm to move thelaparoscope to maintain the target surgical instrument within the fieldof view of the laparoscope. For example, identifying the target surgicalinstrument within the field of view of the laparoscope may comprisedetecting, via the controller, a predefined gestural pattern by thetarget surgical instrument within the field of view of the laparoscope,the predefined gestural pattern comprising positioning of the targetsurgical instrument within a center portion of the field of view of thelaparoscope and maintaining the position of the target surgicalinstrument within the center portion for at least a predetermined holdperiod.

In accordance with another aspect of the present disclosure, aco-manipulation surgical system to assist with laparoscopic surgeryperformed using a surgical instrument is provided. The co-manipulationsurgical system may include a robot arm comprising a plurality of links,a plurality of joints, a proximal end operatively coupled to a base ofthe robot arm, and a distal region having a distal end configured to beremovably coupled to the surgical instrument, and a platform coupled tothe base of the robot arm. The platform may comprise a stage assemblyconfigured to independently move the base of the robot arm in at leasttwo degrees of freedom relative to the platform. Accordingly, in a userguided setup mode, application of a force at the distal region of therobot arm in a first direction may cause the stage assembly to move thebase of the robot arm in a first degree of freedom of the at least twodegrees of freedom relative to the platform.

For example, in the user guided setup mode, the stage assembly may beconfigured to move the base of the robot arm in the first degree offreedom when the force applied at the distal region of the robot arm inthe first direction exceeds a predetermined force threshold. Further, inthe user guided setup mode, the stage assembly may be configured to stopmoving the base of the robot arm in the first degree of freedom when theforce applied at the distal region of the robot arm in the firstdirection falls below a predetermined release threshold. Moreover, inthe user guided setup mode, the stage assembly may be configured to stopmoving the base of the robot arm in the first degree of freedom uponapplication of a counter force at the robot arm in a second directionopposite to the first direction. In addition, in the user guided setupmode, application of a force at the distal region of the robot arm in asecond direction may cause the stage assembly to move the base of therobot arm in a second degree of freedom of the at least two degrees offreedom relative to the platform. The system further may include anactuator configured to be actuated to switch the system to the userguided setup mode. In some embodiments, the system remains in the userguided setup mode only while the actuator is actuated. The actuator maybe disposed on a collar rotatably coupled to a link of the plurality oflinks, such that actuation of the actuator permits rotation of thecollar in a first direction to cause rotation of a distal link of theplurality of links adjacent to a setup joint of the plurality of jointsin a corresponding first direction relative to a proximal link of theplurality of links adjacent to the setup joint, and permits rotation ofthe collar in a second direction to cause rotation of the distal linkadjacent to the setup joint in a corresponding second direction relativeto the proximal link adjacent to the setup joint.

The system further may include a graphical user interface operativelycoupled to the stage assembly. The graphical user interface may beconfigured to display an actuator configured to be actuated to cause thestage assembly to move the base of the robot arm in at least one of theat least two degrees of freedom relative to the platform. For example,the actuator may comprise a slidable cursor configured to be movedrelative to a neutral center point of a cursor pad, such that movementof the slidable cursor in a direction relative to the neutral centerpoint within the cursor pad may cause the stage assembly to move thebase of the robot arm in a corresponding direction relative to theplatform. The stage assembly may be configured to move the base of therobot arm in the corresponding direction relative to the platform at avelocity that correlates with a distance of the slidable cursor from theneutral center point. In addition, the graphical user interface may beconfigured to display one or more indicators, the one or more indicatorsindicative of a configuration of the robot arm relative to the platformin real-time responsive to actuation of the actuator. Moreover, in aco-manipulation mode, the robot arm may be permitted to be freelymoveable responsive to movement at the handle of the surgical instrumentfor performing laparoscopic surgery.

The system further may include a plurality of motors disposed within thebase, the plurality of motors operatively coupled to at least somejoints of the plurality of joints, and a controller operatively coupledto the plurality of motors. The controller may be programmed to: measurecurrent of the plurality of motors, the measured current indicative offorce applied at the distal region of the robot arm; and cause, in theuser guided setup mode, the stage assembly to move the base of the robotarm in at least one of the at least two degrees of freedom based on themeasured current. The controller further may be operatively coupled to asetup joint of the plurality of joints of the robot arm, such that thecontroller may be programmed to: determine if one or more objects arewithin a predetermined proximity threshold of the robot arm; andautomatically rotate a distal link of the plurality of links adjacent tothe setup joint relative to a proximal link of the plurality of linksadjacent to the setup joint to avoid a collision with the one or moreobjects as the stage assembly moves the base of the robot arm in atleast one of the at least two degrees of freedom relative to theplatform in the user guided setup mode.

The system further may include one or more depth sensors configured todetect the one or more objects adjacent to the robot arm, and generateone or more signals indicative of a proximity of the one or more objectsto the robot arm. Accordingly, the controller may be configured todetermine if the one or more objects are within the predeterminedproximity threshold of the robot arm based on the one or more signals.For example, the one or more depth sensors may comprise one or moreproximity sensors disposed within the base of the robot arm, the one ormore proximity sensors comprising at least one of electromagnetic,capacitive, ultrasonic, or infrared proximity sensors. Additionally, oralternatively, the one or more depth sensors may comprise one or moredepth cameras. Accordingly, the controller may be configured to stopmovement of the base of the robot arm via the stage assembly if the oneor more objects are within the predetermined proximity threshold. Theco-manipulation surgical system may not be teleoperated via user inputreceived at a remote surgeon console.

In accordance with another aspect of the present disclosure, a methodfor assisting with laparoscopic surgery using a robot arm comprising aplurality of links, and a plurality of joints, a proximal endoperatively coupled to a base of the robot arm, and a distal regionhaving a distal end configured to be removably coupled to a surgicalinstrument is provided. The method may include: switching, via acontroller operatively coupled to a stage assembly operatively coupledto the base of the robot arm, the system to a user guided setup mode;and causing, via the controller in the user guided setup mode, the stageassembly to move the base of the robot arm in a first degree of freedomof at least two degrees of freedom relative to a platform coupled to thestage assembly upon application of a force at the distal region of therobot arm in a first direction. For example, causing the stage assemblyto move the base of the robot arm in the first degree of freedom maycomprise causing, via the controller in the user guided setup mode, thestage assembly to move the base of the robot arm in the first degree offreedom when the force applied at the distal region of the robot arm inthe first direction exceeds a predetermined force threshold.

The method further may include causing, via the controller in the userguided setup mode, the stage assembly to stop moving the base of therobot arm in the first degree of freedom when the force applied at thedistal region of the robot arm in the first direction falls below apredetermined release threshold. In addition, the method may includecausing, via the controller in the user guided setup mode, the stageassembly to stop moving the base of the robot arm in the first degree offreedom upon application of a counter force at the robot arm in a seconddirection opposite to the first direction. Further, the method mayinclude causing, via the controller in the user guided setup mode, thestage assembly to move the base of the robot arm in a second degree offreedom of the at least two degrees of freedom relative to the platformupon application of a force at the distal region of the robot arm in asecond direction. Moreover, switching the system to the user guidedsetup mode may comprise switching the system to the user guided setupmode responsive to actuation of an actuator operatively coupled to thecontroller, such that the system may remain in the user guided setupmode only while the actuator is actuated.

The method further may include causing, via the controller in the userguided setup mode, the stage assembly to move the base of the robot armin at least one of the at least two degrees of freedom relative to theplatform responsive to actuation of an actuator displayed on a graphicaluser interface operatively coupled to the controller. Accordingly, themethod further may include causing, via the controller in the userguided setup mode, the graphical user interface to display one or moreindicators indicative of a configuration of the robot arm relative tothe platform in real-time responsive to actuation of the actuator. Themethod further may include determining, via the controller in the userguided setup mode, if one or more objects are within a predeterminedproximity threshold of the robot arm; and stopping, via the controllerif the one or more objects are within the predetermined proximitythreshold, movement of the base of the robot arm via the stage assemblyto avoid a collision with the one or more objects as the stage assemblymoves the base of the robot arm in at least one of the at least twodegrees of freedom relative to the platform. Moreover, the method mayinclude switching, via the controller, the system to a co-manipulationmode; and permitting, via the controller in the co-manipulation mode,the robot arm to be freely moveable responsive to movement at a handleof the surgical instrument for performing laparoscopic surgery.

In accordance with another aspect of the present disclosure, aco-manipulation surgical system to assist with laparoscopic surgeryperformed using a surgical instrument having a handle, an operating end,and an elongated shaft therebetween is provided. The co-manipulationsurgical system may include a robot arm comprising a plurality of links,a plurality of joints comprising one or more motorized joints, a setupjoint, and one or more passive joints, a proximal end operativelycoupled to a base of the robot arm, and a distal region having a distalend configured to be removably coupled to the surgical instrument, and aplurality of motors operatively coupled to the one or more motorizedjoints and to the setup joint. In addition, the system may include anactuator operatively coupled to the setup joint and configured to beactuated to cause rotation of a distal link of the plurality of linksadjacent to the setup joint relative to a proximal link of the pluralityof links adjacent to the setup joint from a first setup configuration toa second setup configuration responsive to actuation of the actuator.Accordingly, when the actuator is in an unactuated state, the robot armmay be permitted to be freely moveable responsive to movement at thehandle of the surgical instrument for performing laparoscopic surgeryvia the one or more motorized joints and the one or more passive jointswhile the distal link adjacent to the setup joint and the proximal linkadjacent to the setup joint remain in the second setup configuration.

The actuator may comprise a collar rotatably coupled to a link of theplurality of links, the collar configured to be rotated in a firstdirection relative to the link of the plurality of links to causerotation of the distal link adjacent to the setup joint in acorresponding first direction relative to the proximal link adjacent tothe setup joint, and rotated in a second direction relative to the linkof the plurality of links to cause rotation of the distal link adjacentto the setup joint in a corresponding second direction relative to theproximal link adjacent to the setup joint. Moreover, the collar maycomprise a setup mode actuator, the setup mode actuator configured to beactuated to permit the rotation of the distal link adjacent to the setupjoint in the corresponding first and second directions relative to theproximal link adjacent to the setup joint responsive to rotation of thecollar. The collar may be spring-enforced such that upon release of thecollar in any position, the collar is configured to return to a neutralposition relative to the link of the plurality of links.

The system further may include a graphical user interface operativelycoupled to the setup joint, such that the actuator may be configured tobe displayed on the graphical user interface. For example, the actuatormay comprise a slidable cursor configured to be moved relative to aneutral center point, such that movement of the slidable cursor in afirst direction relative to the neutral center point causes rotation ofthe distal link adjacent to the setup joint in a first directionrelative to the proximal link adjacent to the setup joint, and movementof the slidable cursor in a second direction relative to the neutralcenter point causes rotation of the distal link adjacent to the setupjoint in a second direction relative to the proximal link adjacent tothe setup joint. In some embodiments, the distal link adjacent to thesetup joint may be configured to rotate in the corresponding directionrelative to the proximal link adjacent to the setup joint a velocitythat correlates with a distance of the slidable cursor from the neutralcenter point. In addition, the graphical user interface may beconfigured to display an indicator, the indicator indicative of aconfiguration of the distal link adjacent to the setup joint relative tothe proximal link adjacent to the setup joint in real-time responsive toactuation of the actuator. Additionally, the graphical user interfacemay be configured to display graphical representations of a plurality ofconfigurations of the distal link adjacent to the setup joint relativeto the proximal link adjacent to the setup joint, such that a positionof the indicator relative to the graphical representations of theplurality of configurations may be indicative of the configuration ofthe distal link adjacent to the setup joint relative to the proximallink adjacent to the setup joint in real-time responsive to actuation ofthe actuator.

The system further may include a controller operatively coupled to therobot arm, the controller programmed to cause the robot arm to be freelymoveably responsive to movement at the handle of the surgical instrumentfor performing laparoscopic surgery during an operating stage. Thecontroller may be configured to switch from the operating stage to asetup stage upon actuation of a setup mode actuator, such that actuationof the actuator only causes rotation of the distal link adjacent to thesetup joint relative to the proximal link adjacent to the setup jointwhen the setup mode actuator is in an actuated state. When the actuatoris in an actuated state, application of a force at the distal region ofthe robot arm in a first direction may cause rotation of the distal linkadjacent to the setup joint in a first direction relative to theproximal link adjacent to the setup joint, and application of a force atthe distal region of the robot arm in a second direction causes rotationof the distal link adjacent to the setup joint in a second directionrelative to the proximal link adjacent to the setup joint. Moreover,when the actuator is in the unactuated state, the setup joint may beconfigured to cause the distal and proximal links adjacent to the setupjoint to be fixed relative to each other in the second setupconfiguration. In addition, all motors of the plurality of motorsoperatively coupled to the one or more motorized joints may be disposedwithin the base of the robot arm. Moreover, a shoulder link of theplurality of links may comprise a distal shoulder link rotatably coupledto a proximal shoulder link via the setup joint, and the motor of theplurality of motors operatively coupled to the setup joint may notback-drivable. For example, the motor of the plurality of motorsoperatively coupled to the setup joint may be disposed on the shoulderlink adjacent to the setup joint.

The system further may include a platform operatively coupled to thebase of the robot arm, the platform comprising a stage assemblyconfigured to independently move the base of the robot arm in ahorizontal direction and in a vertical direction relative to theplatform. Accordingly, in a user guided setup mode, application of aforce at the distal region of the robot arm in a first direction maycause the stage assembly to move the base of the robot arm in thehorizontal direction relative to the platform, and application of aforce at the distal region of the robot arm in a second direction maycause the stage assembly to move the base of the robot arm in thevertical direction relative to the platform. The system further mayinclude a setup mode actuator configured to be actuated to switch thesystem to the user guided setup mode, such that the system may remain inthe user guided setup mode only while the setup mode actuator isactuated. In some embodiments, the actuator may comprise a collarrotatably coupled to a link of the plurality of links, such that thesetup mode actuator may be disposed on the collar. Accordingly,actuation of the setup mode actuator may permit rotation of the collarin a first direction to cause rotation of the distal link adjacent tothe setup joint in a corresponding first direction relative to theproximal link adjacent to the setup joint, and may permit rotation ofthe collar in a second direction to cause rotation of the distal linkadjacent to the setup joint in a corresponding second direction relativeto the proximal link adjacent to the setup joint. The co-manipulationsurgical system may not be teleoperated via user input received at aremote surgeon console.

In accordance with another aspect of the present disclosure, a methodfor assisting with laparoscopic surgery using a robot arm comprising aplurality of links, a plurality of joints comprising one or moremotorized joints, a setup joint, and one or more passive joints, aproximal end operatively coupled to a base of the robot arm, and adistal region having a distal end configured to be removably coupled toa surgical instrument is provided. The method may include: actuating anactuator operatively coupled to a motor operatively coupled to the setupjoint to cause rotation of a distal link of the plurality of linksadjacent to the setup joint relative to a proximal link of the pluralityof links adjacent to the setup joint from a first setup configuration toa second setup configuration responsive to actuation of the actuator;and moving, when the actuator is in an unactuated state, the robot armresponsive to movement at the handle of the surgical instrument forperforming laparoscopic surgery via the one or more motorized joints andthe one or more passive joints while the distal link adjacent to thesetup joint and proximal link adjacent to the setup joint remain in thesecond setup configuration. For example, actuating the actuator to causerotation of the distal link adjacent to the setup joint relative to theproximal link adjacent to the setup joint may comprise rotating a collarrotatably coupled to a link of the plurality of links in a firstdirection to cause rotation of the distal link adjacent to the setupjoint in a corresponding first direction relative to the proximal linkadjacent to the setup joint, and rotating the collar in a seconddirection to cause rotation of the distal link adjacent to the setupjoint in a corresponding second direction relative to the proximal linkadjacent to the setup joint. Moreover, actuating the actuator to causerotation of the distal link adjacent to the setup joint relative to theproximal link adjacent to the setup joint further may comprise actuatinga setup mode actuator disposed on the collar to permit the rotation ofthe distal link adjacent to the setup joint in the corresponding firstand second directions relative to the proximal link adjacent to thesetup joint responsive to rotation of the collar.

In addition, actuating the actuator to cause rotation of the link distalto the setup joint relative to the link proximal to the setup joint maycomprise actuating the actuator displayed on a graphical user interface.For example, actuating the actuator displayed on the graphical userinterface may comprise moving a slidable cursor relative to a neutralcenter point, such that movement of the slidable cursor in a firstdirection relative to the neutral center point causes rotation of thedistal link adjacent to the setup joint in a first direction relative tothe proximal link adjacent to the setup joint, and movement of theslidable cursor in a second direction relative to the neutral centerpoint causes rotation of the distal link adjacent to the setup joint ina second direction relative to the proximal link adjacent to the setupjoint. Accordingly, the method further may include displaying, via thegraphical user interface, an indicator indicative of a configuration ofthe distal link adjacent to the setup joint relative to the proximallink adjacent to the setup joint in real-time responsive to actuation ofthe actuator.

In addition, the method may include displaying, via the graphical userinterface, graphical representations of a plurality of configurations ofthe distal link adjacent to the setup joint relative to the proximallink adjacent to the setup joint, such that a position of the indicatorrelative to the graphical representations of the plurality ofconfigurations is indicative of the configuration of the distal linkadjacent to the setup joint relative to the proximal link adjacent tothe setup joint in real-time responsive to actuation of the actuator.Moreover, actuating the actuator to cause rotation of the link distal tothe setup joint relative to the link proximal to the setup joint maycomprise applying, when the actuator is in an actuated state, a force atthe distal region of the robot arm in a direction to cause rotation ofthe distal link adjacent to the setup joint in a corresponding directionrelative to the proximal link adjacent to the setup joint. The methodfurther may include applying, in a user guided setup mode, a force atthe distal region of the robot arm in a direction to cause a stageassembly operatively coupled to the base of the robot arm to move thebase of the robot arm in a corresponding direction relative to aplatform coupled to the stage assembly.

In accordance with another aspect of the present disclosure, aco-manipulation surgical system for providing adaptive gravitycompensation to a robot arm comprising a plurality of links, a pluralityof joints, and a distal end configured to be removably coupled to asurgical instrument is provided. The co-manipulation surgical system maycomprise at least one processor configured to: apply an initial gravitycompensation to the robot arm to compensate for gravity of the surgicalinstrument based on an estimated instrument parameter associated withthe surgical instrument; calculate, during application of the initialgravity compensation, a hold force required to maintain the distal endof the robot arm in a static position in a passive mode; and determine acalibrated instrument parameter for the surgical instrument based on thehold force, the calibrated instrument parameter selected to adjust thehold force required to maintain the distal end of the robot arm in thestatic position in the passive mode during application of an adjustedgravity compensation to the robot arm based on the calibrated instrumentparameter.

The at least one processor further may be configured to apply torque toone or more motorized joints of the plurality of joints of the robot armto apply the initial gravity compensation to the robot arm to compensatefor gravity of the surgical instrument. The estimated instrumentparameter and the calibrated instrument parameter may comprise at leastone of a mass or a center of mass associated with the surgicalinstrument. In addition, the at least one processor may be configuredto: load a calibration file associated with a known parameter of thesurgical instrument, such that the calibration file may comprise theestimated instrument parameter. For example, the known parameter maycomprise a diameter of an elongated shaft of the surgical instrument.Moreover, the at least one processor may be configured to determine theknown parameter upon coupling of the surgical instrument to the distalend of the robot arm via a coupler body removably coupled to thesurgical instrument and to the distal end of the robot arm. In someembodiments, the at least one processor may be configured to determinethe known parameter based on the coupler body. The system further mayinclude an optical sensor configured to collect depth data, such thatthe at least one processor may be configured to determine the knownparameter based on the depth data. Additionally, or alternatively, thesystem may include a user interface operatively coupled to the at leastone processor, such that the at least one processor is configured todetermine the known parameter via user input received by the userinterface.

The calibrated instrument parameter may be selected to adjust the holdforce during application of the adjusted gravity compensation based onthe calibrated instrument parameter within a predetermined rangeassociated with a known parameter of the surgical instrument. Moreover,when the distal end of the robot arm is not subjected to any externalforces other than gravity on the robot arm and the surgical instrumentin the static position, the calibrated instrument parameter may beselected to adjust the hold force to or near zero upon application ofthe adjusted gravity compensation based on the calibrated instrumentparameter. In addition, when the distal end of the robot arm issubjected to one or more external forces in addition to gravity on therobot arm and the surgical instrument in the static position, thecalibrated instrument parameter may be selected to adjust the hold forcewithin a predetermined range associated with a known parameter of thesurgical instrument.

The at least one processor further may be configured to: calculate theadjusted gravity compensation of the surgical instrument based on thecalibrated instrument parameter; and apply the adjusted gravitycompensation to the robot arm to compensate for gravity of the surgicalinstrument. For example, the at least one processor may be configured toapply torque to one or more motorized joints of the plurality of jointsof the robot arm to apply the adjusted gravity compensation to the robotarm to compensate for gravity of the surgical instrument. Moreover, theat least one processor may be configured to cause the robot arm toautomatically switch to a co-manipulation mode responsive to determiningthat force applied at the robot arm due to force applied at a handle ofthe surgical instrument exceeds a predetermined force threshold.Additionally, the at least one processor may be configured to permit therobot arm to be freely moveable in the co-manipulation mode responsiveto movement at the handle of the surgical instrument, while applying theadjusted gravity compensation to the robot arm to compensate for gravityof the surgical instrument in the co-manipulation mode.

The at least one processor further may be configured to calculate theadjusted hold force to maintain the distal end of the robot arm in thestatic position in the passive mode upon application of the adjustedgravity compensation. Accordingly, the at least one processor may beconfigured to: establish a baseline hold force based on the adjustedhold force after a predetermined time period upon initiation of thepassive mode; and apply a predetermined constant breakaway forcethreshold to the robot arm based on the baseline hold force, such thatthe at least one processor may not maintain the distal end of the robotarm in the static position if the hold force exceeds the predeterminedconstant breakaway force threshold. In addition, the at least oneprocessor may be configured to apply a predetermined high breakawayforce threshold during the predetermined time period, such that the atleast one processor may not maintain the distal end of the robot arm inthe static position if the hold force exceeds the predetermined highbreakaway force threshold during the predetermined time period.Moreover, the at least one processor may be configured to cause therobot arm to automatically switch to the passive mode responsive todetermining that movement of the robot arm due to movement at a handleof the surgical instrument is less than a predetermined amount for atleast a predetermined dwell time period. The at least one processorfurther may be configured to record the calibrated instrument parameterin a calibration file associated with the surgical instrument.

In accordance with another aspect of the present disclosure, a methodfor assisting with laparoscopic surgery using a robot arm comprising aproximal end, a distal end configured to be removably coupled to asurgical instrument, a plurality of links, and a plurality of jointsbetween the proximal end and the distal end is provided. The method mayinclude: applying, via a controller operatively coupled to the robotarm, an initial gravity compensation to the robot arm to compensate forgravity of the surgical instrument when the surgical instrument iscoupled to the distal end of the robot arm based on an estimatedinstrument parameter associated with the surgical instrument;calculating, via the controller during application of the initialgravity compensation, a hold force required to maintain the distal endof the robot arm in a static position in a passive mode; anddetermining, via the controller, a calibrated instrument parameter forthe surgical instrument based on the hold force, the calibratedinstrument parameter selected to adjust the hold force required tomaintain the distal end of the robot arm in the static position in thepassive mode during application of an adjusted gravity compensation tothe robot arm based on the calibrated instrument parameter. Theestimated instrument parameter and the calibrated instrument parametermay comprise at least one of a mass or a center of mass associated withthe surgical instrument.

The method further may include loading, via the controller, acalibration file associated with a known parameter of the surgicalinstrument, such that the calibration file may comprise the estimatedinstrument parameter. For example, the known parameter may comprise adiameter of an elongated shaft of the surgical instrument. In addition,the method may include: coupling the surgical instrument to the distalend of the robot arm via a coupler body removably coupled to thesurgical instrument; and determining, via the controller, the knownparameter based on the coupler body. Additionally, the method mayinclude determining, via the controller, the known parameter via userinput received by a user interface operatively coupled to thecontroller. Moreover, determining the calibrated instrument parameterbased on the hold force may comprise determining the calibratedinstrument parameter selected to adjust the hold force upon applicationof the adjusted gravity compensation within a predetermined rangeassociated with a known parameter of the surgical instrument. The methodfurther may include: calculating, via the controller, the adjustedgravity compensation of the surgical instrument based on the calibratedinstrument parameter; and applying, via the controller, torque to one ormore motorized joints of the plurality of joints of the robot arm toapply the adjusted gravity compensation to the robot arm to compensatefor gravity of the surgical instrument.

In addition, the method may include: automatically switching, via thecontroller, to a co-manipulation mode responsive to determining thatforce applied at the robot arm due to force applied at the handle of thesurgical instrument exceeds a predetermined force threshold; andpermitting, via the controller, the robot arm to be freely moveable inthe co-manipulation mode responsive to movement at the handle of thesurgical instrument, while applying the adjusted gravity compensation tothe robot arm to compensate for gravity of the surgical instrument inthe co-manipulation mode. The method further may include: calculating,via the controller, the adjusted hold force to maintain the distal endof the robot arm in the static position in the passive mode uponapplication of the adjusted gravity compensation; establishing, via thecontroller, a baseline hold force based on the adjusted hold force aftera predetermined time period upon initiation of the passive mode; andapplying, via the controller, a predetermined constant breakaway forcethreshold to the robot arm based on the baseline hold force, wherein thecontroller does not maintain the distal end of the robot arm in thestatic position if the hold force exceeds the predetermined constantbreakaway force threshold.

In accordance with another aspect of the present disclosure, aco-manipulation surgical system for operating a robot arm comprising aplurality of links, a plurality of joints, and a distal end configuredto be removably coupled to a surgical instrument is provided. Theco-manipulation surgical system may comprise at least one processorconfigured to: cause the robot arm to switch to a passive moderesponsive to determining that movement of the robot arm due to movementat a handle of the surgical instrument is less than a predeterminedamount for at least a predetermined dwell time period, the at least oneprocessor configured to cause the robot arm to maintain a staticposition in the passive mode; apply gravity compensation to the robotarm to compensate for gravity of the surgical instrument; calculate,during application of the gravity compensation, a hold force required tomaintain the distal end of the robot arm in the static position in thepassive mode; establish a baseline hold force based on the hold force;and apply a breakaway force threshold to the robot arm based on thebaseline hold force, the breakaway force threshold being a predeterminedamount of force required to be applied to the robot arm to cause therobot arm to exit the passive mode. A magnitude of the breakaway forcethreshold may be equal in every direction relative to the baseline holdforce. For example, a total amount of force required to be applied tothe robot arm in a direction to cause the robot arm to exit the passivemode may be a sum of the baseline hold force and the breakaway forcethreshold in the direction.

The hold force required to maintain the distal end of the robot arm inthe static position may be continuously calculated in the passive mode.Accordingly, the at least one processor may be configured to determinethat the surgical instrument is in contact with one or more anatomicalstructures in the passive mode if the hold force gradually increasesover time. In addition, the at least one processor may be configured tocalculate the hold force required to maintain the distal end of therobot arm in the static position in the passive mode when one or moreexternal forces are applied to the surgical instrument by one or moreanatomical structures having an unknown mass. Moreover, the at least oneprocessor may be configured to determine a force required to be appliedto the distal end of the robot arm to move the distal end of the robotarm from a current position to the static position to calculate the holdforce required to maintain the distal end of the robot arm in the staticposition in the passive mode. The at least one processor may further beconfigured to cause the robot arm to automatically switch to aco-manipulation mode responsive to determining that the hold forcerequired to maintain the distal end of the robot arm in the staticposition exceeds the breakaway force threshold, such that the at leastone processor may be configured to permit the robot arm to be freelymoveable in the co-manipulation mode responsive to movement at thehandle of the surgical instrument, while applying the gravitycompensation to the robot arm to compensate for gravity of the surgicalinstrument in the co-manipulation mode.

The at least one processor may be configured to sense a force applied atthe distal end of the robot arm to calculate the hold force required tomaintain the distal end of the robot arm in the static position in thepassive mode. For example, the at least one processor may be configuredto measure current of a plurality of motors operatively coupled to atleast some joints of the plurality of joints to sense the force appliedat the distal end of the robot arm. Moreover, the at least one processormay be configured to apply torque to at least some joints of theplurality of joints of the robot arm to apply the gravity compensationto the robot arm to compensate for gravity of the surgical instrument.

In addition, the at least one processor may be configured to establishthe baseline hold force after a predetermined time period uponinitiation of the passive mode. Accordingly, the at least one processormay be configured to: apply a high breakaway force threshold to therobot arm during the predetermined time period, the high breakaway forcethreshold greater than the breakaway force threshold, such that the atleast one processor may be configured to cause, if the hold forcerequired to maintain the distal end of the robot arm in the staticposition exceeds the high breakaway force threshold during thepredetermined time period, the robot arm to exit the passive mode. Forexample, the high breakaway force threshold may be selected to preventinadvertent disengagement of the robot arm from passive mode in responseto inadvertent forces applied at the distal end of the robot arm duringthe predetermined time period. The at least one processor may further beconfigured to: apply an initial breakaway force threshold to the robotarm during the predetermined time period; and apply, if force applied atthe distal end of the robot arm exceeds the initial breakaway forcethreshold during the predetermined time period, a high breakaway forcethreshold during the predetermined time period, the high breakaway forcethreshold greater than the breakaway force threshold, such that the atleast one processor may be configured to cause, if the hold forcerequired to maintain the distal end of the robot arm in the staticposition exceeds the high breakaway force threshold during thepredetermined time period, the robot arm to exit the passive mode.

Moreover, the at least one processor may be configured to: apply, if thehold force fluctuates after the predetermined time period uponinitiation of the passive mode such that the baseline hold force cannotbe established based on the calculated hold force, a default breakawayforce threshold to the robot arm, such that the at least one processormay be configured to cause, if the hold force required to maintain thedistal end of the robot arm in the static position exceeds the defaultbreakaway force threshold, the robot arm to exit the passive mode. Forexample, the at least one processor may be configured to select thedefault breakaway force threshold from between a default high breakawayforce threshold and a default low breakaway force threshold based onuser input via a graphical user interface operatively coupled to the atleast one processor. Additionally, the at least one processor may beconfigured to adjust at least one of the default high breakaway forcethreshold or the default low breakaway force threshold based on userinput via the graphical user interface.

The at least one processor may further be configured to: apply thegravity compensation to the robot arm to compensate for gravity of thesurgical instrument based on an estimated instrument parameterassociated with the surgical instrument; determine a calibratedinstrument parameter for the surgical instrument based on the holdforce; and apply an adjusted gravity compensation to the robot arm basedon the calibrated instrument parameter, such that the baseline holdforce may be established based on the hold force required to maintainthe distal end of the robot arm in the static position in the passivemode upon application of the adjusted gravity compensation to the robotarm. Moreover, the calibrated instrument parameter may be selected suchthat, during application of the adjusted gravity compensation, the holdforce is adjusted within a predetermined range associated with a knownparameter of the surgical instrument.

In accordance with another aspect of the present disclosure, a methodfor assisting with laparoscopic surgery using a robot arm comprising aproximal end, a distal end configured to be removably coupled a surgicalinstrument, a plurality of links, and a plurality of joints between theproximal end and the distal end is provided. The method may include:causing, via a controller operatively coupled to the robot arm, therobot arm to switch to a passive mode responsive to determining thatmovement of the robot arm due to movement at a handle of the surgicalinstrument is less than a predetermined amount for at least apredetermined dwell time period, the controller configured to cause therobot arm to maintain a static position in the passive mode; applying,via the controller, gravity compensation to the robot arm to compensatefor gravity of the surgical instrument; calculating, via the controllerduring application of the gravity compensation, a hold force required tomaintain the distal end of the robot arm in a static position in thepassive mode; establishing, via the controller, a baseline hold forcebased on the hold force; and applying, via the controller, a breakawayforce threshold to the robot arm based on the baseline hold force, thebreakaway force threshold being a predetermined amount of force requiredto be applied to the robot arm to cause the robot arm to exit thepassive mode. A magnitude of the breakaway force threshold may be equalin every direction relative to the baseline hold force, and a totalamount of force required to be applied to the robot arm in a directionto cause the robot arm to exit the passive mode may be a sum of thebaseline hold force and the breakaway force threshold in the direction.

Calculating the hold force required to maintain the distal end of therobot arm in the static position in the passive mode may comprisecontinuously calculating, via the controller, the hold force required tomaintain the distal end of the robot arm in the static position in thepassive mode. In addition, calculating the hold force required tomaintain the distal end of the robot arm in the static position in thepassive mode may comprise calculating, via the controller, the holdforce required to maintain the distal end of the robot arm in the staticposition in the passive mode when one or more external forces areapplied to the surgical instrument by one or more anatomical structureshaving an unknown mass. The method further may include causing, via thecontroller, the robot arm to automatically switch to a co-manipulationmode responsive to determining that the hold force required to maintainthe distal end of the robot arm in the static position exceeds thebreakaway force threshold, such that the robot arm may be permitted tobe freely moveable in the co-manipulation mode responsive to movement atthe handle of the surgical instrument, while the gravity compensation isapplied to the robot arm to compensate for gravity of the surgicalinstrument in the co-manipulation mode. Establishing the baseline holdforce based on the hold force may comprise establishing, via thecontroller, the baseline hold force after a predetermined time periodupon initiation of the passive mode. Accordingly, the method further mayinclude: applying, via the controller, a high breakaway force thresholdto the robot arm during the predetermined time period, the highbreakaway force threshold greater than the breakaway force threshold;and causing, via the controller if the hold force required to maintainthe distal end of the robot arm in the static position exceeds the highbreakaway force threshold during the predetermined time period, therobot arm to exit the passive mode.

The method further may include: applying, via the controller, if thehold force fluctuates after the predetermined time period uponinitiation of the passive mode such that the baseline hold force cannotbe established based on the calculated hold force, a default breakawayforce threshold to the robot arm; and causing, via the controller if thehold force required to maintain the distal end of the robot arm in thestatic position exceeds the default breakaway force threshold, the robotarm to exit the passive mode. Moreover, applying gravity compensation tothe robot arm to compensate for gravity of the surgical instrument maycomprise applying, via the controller, the gravity compensation to therobot arm to compensate for gravity of the surgical instrument based onan estimated instrument parameter associated with the surgicalinstrument. Accordingly, the method further may include: determining,via the controller, a calibrated instrument parameter for the surgicalinstrument based on the hold force; and applying, via the controller, anadjusted gravity compensation to the robot arm based on the calibratedinstrument parameter, such that establishing the baseline hold forcebased on the hold force may comprise establishing, via the controller,the baseline hold force based on the hold force required to maintain thedistal end of the robot arm in the static position in the passive modeupon application of the adjusted gravity compensation to the robot arm.

In accordance with another aspect of the present disclosure, anotherco-manipulation surgical system to assist with laparoscopic surgeryperformed using a surgical instrument having a handle, an operating end,and an elongated shaft therebetween is provided. The system may includea robot arm comprising a proximal end, a distal end configured to beremovably coupled to the surgical instrument, a plurality of links, anda plurality of joints, and a controller operatively coupled to the robotarm and configured to permit the robot arm to be freely moveableresponsive to movement at the handle of the surgical instrument forperforming the surgical procedure using the surgical instrument. Thecontroller may be programmed to: identify a type of the surgicalinstrument coupled to the distal end of the robot arm; apply a firstimpedance to the robot arm to account for weight of the surgicalinstrument and the robot arm; and apply a second impedance to the robotarm based on the type of the surgical instrument to adjust viscosity atthe distal end of the robot arm to thereby guide a movement of thesurgical instrument by the user during a predetermined phase of thesurgical procedure.

For example, the identified type of the surgical instrument may comprisea suturing device, and the predetermined phase of the surgical proceduremay comprise a suturing phase, such that the second impedance may besufficient to provide more viscous control of the suturing device duringthe suturing phase of the surgical procedure. Additionally, oralternatively, the identified type of the surgical instrument maycomprise a stapling device, and the predetermined phase of the surgicalprocedure may comprise a stapling phase, such that the second impedancemay be sufficient to provide stiff grounding to facilitate forceapplication of the stapling device during the stapling phase of thesurgical procedure. The controller may further be configured to identifythe predetermined phase of the surgical procedure based on the type ofthe surgical instrument. Moreover, the type of the surgical instrumentmay be selected from a list comprising at least one of a wristedinstrument, a stapling device, a dissection device, a suturing device, aretraction device, a tissue removal device, or a clip applier device.The controller may be configured to apply the second impedance to therobot arm based on the type of the surgical instrument to adjustviscosity at the distal end of the robot arm to thereby guide themovement of the surgical instrument by the user during the predeterminedphase of the surgical procedure without actively causing movement of therobot arm.

In accordance with another aspect of the present disclosure, a computerimplemented system for providing image registration to a robot armcomprising a plurality of links, a plurality of joints, and a distal endconfigured to be removably coupled to a laparoscope having a rotatablecamera sensor module is provided. The system may comprise at least oneprocessor configured to: retrieve a plurality of images from thelaparoscope during movement of a field of view of the laparoscope;compute motion of individual pixels between consecutive images of theplurality of images via a computer vision technique, the motion ofindividual pixels indicative of image motion; calculate an average ofthe motion of individual pixels in an x and y direction of the pluralityof images to obtain an image motion direction; and compute an angularoffset between the camera sensor module and the distal end of the robotarm based on the image motion direction.

The at least one processor further may be configured to: synchronize theimage motion and movement of the distal end of the robot arm associatedwith the movement of the field of view of the laparoscope; and comparethe image motion direction with the movement of the distal end of therobot arm to compute the angular offset between the camera sensor moduleand the distal end of the robot arm. Moreover, the at least oneprocessor may be configured to cause, in a foreground mode, the robotarm to move the laparoscope along a predetermined trajectory, such thatthe image motion may be synchronized with movement of the distal end ofthe robot arm associated with movement of the laparoscope along thepredetermined trajectory. Additionally, or alternatively, in abackground mode, the image motion may be synchronized with movement ofthe distal end of the robot arm responsive to movement of the field ofview of the laparoscope by a user. The at least one processor may beconfigured to retrieve data indicative of the movement of the distal endof the robot arm via one or more sensors operatively coupled to at leastsome joints of the plurality of joints of the robot arm.

Moreover, the at least one processor may be configured to validate theimage motion direction. For example, the at least one processor may beconfigured to: calculate a norm of a vector of the image motiondirection to determine a magnitude of the image motion; and compare themagnitude of the image motion with a magnitude threshold. Accordingly,the image motion direction may be validated if the magnitude of theimage motion exceeds the magnitude threshold. Additionally, oralternatively, the at least one processor may be configured to:calculate a percentage of image pixels that moved between consecutiveimages based on the motion of individual pixels; and compare thepercentage with a percentage threshold. Accordingly, the image motiondirection may be validated if the percentage exceeds the percentagethreshold. The at least one processor may be configured to determinewhether the image motion is due to at least one of movement of the fieldof view of the laparoscope or local motion of one or more tools ortissue within the plurality of images based on the comparison of thepercentage with the percentage threshold. Additionally, oralternatively, the at least one processor may be configured to:calculate a relative angle between each motion of the individual pixelsand the image motion direction to determine whether each motion of theindividual pixels are in agreement with the image motion direction; andcompare a percentage of individual pixels motion that are in agreementwith the image motion direction with an agreement threshold.Accordingly, the image motion direction may be validated if thepercentage exceeds the agreement threshold.

The at least one processor further may be configured to: cause the robotarm to move the laparoscope along a predetermined axial trajectory;compare the image motion direction with a direction threshold; anddetermine whether the laparoscope has a flat or angled tip based on thecomparison of the image motion direction with the direction threshold.In some embodiments, movement of the field of view of the laparoscopemay be due to zooming of the camera sensor module, such that the atleast one processor may be configured to: compare the image motiondirection with a direction threshold; and determine whether thelaparoscope has a flat or angled tip based on the comparison of theimage motion direction with the direction threshold. The controllerfurther may be configured to cause the robot arm to automatically switchto a co-manipulation mode responsive to determining that force appliedat the robot arm due to force applied at the laparoscope exceeds apredetermined threshold. Accordingly, the controller may be configuredto permit the robot arm to be freely moveable in the co-manipulationmode responsive to movement at the laparoscope, while applying animpedance to the robot arm in the co-manipulation mode to account forweight of the laparoscope and the robot arm.

In accordance with another aspect of the present disclosure, a systemfor robotic surgery is provided. The system may include a robot armcomprising a proximal end operatively coupled to a base of the robotarm, a distal end, a plurality of links, and a plurality of jointsbetween the proximal end and the distal end, and the robot arm may beconfigured to be positioned adjacent to a bed for holding a patientduring surgery. The system further may include a platform coupled to thebase of the robot arm, and the platform may comprise a stage assemblyconfigured to independently move the base of the robot arm in at leasttwo degrees of freedom relative to the platform. In addition, the systemmay include a graphical user interface comprising a plurality ofpredetermined, selectable surgical procedures, and a controlleroperatively coupled to the robot arm. The controller may be programmedto: during a surgery setup phase, automatically position the robot armin a first position specific to a first surgical procedure relative tothe bed in response to selection of the first surgical procedure of theplurality of predetermined, selectable surgical procedures; and duringthe surgery setup phase, automatically position the robot arm in asecond position specific to a second surgical procedure relative to thebed in response to selection of the second surgical procedure of theplurality of predetermined, selectable surgical procedures. For example,the first position specific to the first surgical procedure may bedifferent than the second position specific to the second surgicalprocedure.

Moreover, the controller may be configured to, upon selection of thecholecystectomy: cause a shoulder link of the plurality of links of therobot arm to rotate in a leftward direction relative to the platform;and cause the stage assembly to move the base of the robot arm in adownward direction of a first degree of freedom of the at least twodegrees of freedom and in an outward direction of a second degree offreedom of the at least two degrees of freedom. In addition, the systemmay include a second robot arm, such that the controller may beconfigured to, upon selection of the cholecystectomy, cause a stageassembly of the second robot arm to move a base of the second robot armin an upward direction of a first degree of freedom of at least twodegrees of freedom and in an inward direction of a second degree offreedom of the at least two degrees of freedom. At least one of thefirst or second surgical procedures may comprise a cholecystectomy,gastric sleeve, hiatal hernia repair, Nissen fundoplication, inguinalhernia repair (TEP), right, left, and/or complete colectomy, gastricbypass, sigmoid colectomy, umbilical hernia repair, or incisional herniarepair.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B illustrate a traditional laparoscopic procedureperformed by a surgeon and one or more assistants.

FIG. 2A illustrates an exemplary co-manipulation surgical systemconstructed in accordance with the principles of the present disclosure.

FIGS. 2B and 2C illustrate an exemplary platform of the system of FIG.2A constructed in accordance with the principles of the presentdisclosure.

FIG. 2D illustrates movement of an exemplary stage assembly of theplatform of FIGS. 2B and 2C in accordance with the principles of thepresent disclosure.

FIG. 2E illustrates proximity sensors within a base of a robot arm ofthe system of FIG. 2A.

FIG. 3 illustrates an exemplary robot arm of the system of FIG. 2Aconstructed in accordance with the principles of the present disclosure.

FIG. 4 illustrates another exemplary robot arm of the system of FIG. 2Aconstructed in accordance with the principles of the present disclosure.

FIGS. 5A and 5B illustrate an exemplary surgical instrument couplingmechanism at the distal end of the robot arm of FIG. 3 constructed inaccordance with the principles of the present disclosure.

FIG. 6 illustrate an exemplary coupler interface of the surgicalinstrument coupling mechanism of FIGS. 5A and 5B.

FIGS. 7A-7C illustrate an exemplary coupler body of the surgicalinstrument coupling mechanism of FIGS. 5A and 5B.

FIGS. 7D to 7H illustrate an alternative exemplary surgical instrumentcoupling mechanism constructed in accordance with the principles of thepresent disclosure.

FIG. 8A is a cross-sectional view of the coupler body of FIG. 7A whenthe coupler body is detached from the coupler interface.

FIG. 8B is a cross-sectional view of the surgical instrument couplingmechanism of FIG. 5A when the coupler body is coupled to the couplerinterface.

FIG. 8C is a cross-sectional view of the surgical instrument couplingmechanism of FIG. 5A when a surgical instrument is coupled to thecoupler body.

FIG. 9 is a cross-sectional view of another exemplary surgicalinstrument coupling mechanism when a surgical instrument is coupled tothe coupler body, constructed in accordance with the principles of thepresent disclosure.

FIGS. 10A and 10B illustrate the robot arms in a sterile-drape readyconfiguration.

FIGS. 10C and 10D illustrate the robot arms covered in a sterile drape.

FIG. 10E illustrates an exemplary sterile drape having first and seconddrape portions constructed in accordance with the principles of thepresent disclosure.

FIG. 10F illustrates a drape guide of the sterile drape of FIG. 10E.

FIG. 10G illustrates a drape hook on the platform for supporting thesterile drape of FIG. 10E.

FIGS. 11A-11D illustrate rotation of the shoulder link of the robot armin accordance with the principles of the present disclosure.

FIG. 12A illustrates a field of view of the optical scanner during alaparoscopic surgical procedure, and FIG. 12B illustrates a depth map ofthe field of view the optical scanner of FIG. 12A.

FIGS. 13A-13D illustrate setup of the co-manipulation surgical system inaccordance with the principles of the present disclosure.

FIG. 14 shows some example components that may be included in aco-manipulation robot platform in accordance with the principles of thepresent disclosure.

FIG. 15 illustrates an exemplary virtual overlay of a graphical userinterface of the co-manipulation surgical system.

FIG. 16 is a table of example values related to some arrangements of apassive mode of the robot arm in accordance with the principles of thepresent disclosure.

FIG. 17A is a flow chart illustrating training of the co-manipulationsurgical system to identify and track a surgical instrument forinstrument centering in accordance with the principles of the presentdisclosure.

FIG. 17B is a flow chart illustrating robot arm trajectory generationfor instrument centering in accordance with the principles of thepresent disclosure.

FIG. 18 is a flow chart illustrating operation of the co-manipulationsurgical system in accordance with the principles of the presentdisclosure.

FIG. 19 is a flow chart illustrating surgical instrument calibration ofthe co-manipulation surgical system in accordance with the principles ofthe present disclosure.

FIG. 20 is a flow chart illustrating operation of the robot arm inaccordance with the principles of the present disclosure.

FIG. 21 is a flow chart illustrating instrument centering in accordancewith the principles of the present disclosure.

FIG. 22 illustrates an exemplary tracking overlay of a graphical userinterface of the co-manipulation surgical system.

FIGS. 23A and 23B are free-body diagrams illustrating forces applied tothe surgical instrument coupled to the robot arm during a laparoscopicsurgical procedure.

FIGS. 23C-23E are free-body diagrams illustrating movement of thesurgical instrument coupled to the robot arm along a trajectory forinstrument centering.

FIG. 24 illustrates an exemplary adaptive gravity compensation processfor dynamically adjusting gravity compensation in accordance with theprinciples of the present disclosure.

FIGS. 25A and 25B illustrate adaptive gravity compensation as applied toa robot arm coupled to a surgical instrument subjected to externalforces in addition to gravity.

FIGS. 26A-26C illustrate hold force over time to establish a breakawayforce threshold based on the hold force in accordance with theprinciples of the present disclosure.

FIG. 27A illustrates the breakaway force threshold independent of thehold force, and FIG. 27B illustrates the breakaway force threshold basedon the hold force.

FIG. 28A illustrates a conventional laparoscope device, and FIG. 28Billustrates the laparoscope device coupled to the distal end of therobot arm.

FIG. 29 is a flow chart illustrating an exemplary framework fordetecting and determining an angular offset between a laparoscopiccamera sensor module and the distal end of the robot arm in accordancewith the principles of the present disclosure.

FIG. 30A illustrates determination of image motion direction via acomputer vision technique, and FIG. 30B illustrates motion of alaparoscopic video feed along an image motion direction.

FIG. 31 illustrates exemplary pivoting motion for computing an angularoffset between a laparoscopic camera sensor module and the distal end ofthe robot arm.

FIG. 32 illustrates an example overview of some features andcapabilities of the co-manipulation surgical system in accordance withthe principles of the present disclosure.

FIG. 33 illustrates a virtual map of the co-manipulation surgical systemwithin an operating room.

FIG. 34 is a schematic overview of some electrical components andconnectivity of the co-manipulation surgical system in accordance withthe principles of the present disclosure.

FIG. 35 is a flow chart illustrating an example process of acquisitionand processing of data from an imaging device and example applicationsof the data in accordance with the principles of the present disclosure.

FIG. 36 is a schematic overview of data flow of the co-manipulationsurgical system in accordance with the principles of the presentdisclosure.

FIG. 37 is another schematic overview of data flow the co-manipulationsurgical system in accordance with the principles of the presentdisclosure.

FIG. 38 is a schematic overview of data flow in a network ofco-manipulation surgical systems in accordance with the principles ofthe present disclosure.

FIGS. 39A-39R illustrate an exemplary graphical user interface of theco-manipulation surgical system.

FIGS. 40A-40C illustrate an exemplary graphical user interface of theco-manipulation surgical system displaying a virtual map in accordancewith the principles of the present disclosure.

FIG. 41 illustrates the degrees of freedom of movement of the shoulderportion and the stages of co-manipulation surgical system for presetconfigurations of the platform and robot arms in accordance with theprinciples of the present disclosure.

DETAILED DESCRIPTION

Disclosed herein are co-manipulation surgical robot systems forassisting an operator, e.g., a surgeon, in performing a surgicalprocedure, e.g., a laparoscopic procedure, and methods of use thereof.Currently, laparoscopic procedures typically require a surgeon and oneor more assistants. For example, as shown in FIG. 1A, during alaparoscopic procedure assistant A1 may be required to hold retractordevice 12 to expose tissue for surgeon S, while another assistant A2 maybe required to hold laparoscope device 10 to provide a field of view ofthe surgical space within the patient to surgeon S via a display (notshown) during the procedure. As shown in FIG. 1A, assistant A2 may berequired to hold laparoscope device 10 in an impractical position, e.g.,from between the arms of surgeon S while the surgeon actively operatesadditional surgical instruments, e.g., surgical instruments 14 and 16.As further shown in FIG. 1A, surgeon S may need to let go of surgicalinstrument 16 in order to guide/reposition laparoscope device 10 held byassistant A2 in order to achieve the field of view desired by thesurgeon.

As shown in FIG. 1B, rail-mounted orthopedic retractors 18 may be usedto hold one or more surgical instruments in position during thelaparoscopic procedure, in attempt to free hands of the surgeon and/orassistant for other tasks, as well as for stability. As shown in FIG.1B, first rail-mounted orthopedic retractor 18 a may include retractorend 20 a for engaging with and holding laparoscope device 10 in positionupon actuation of lock 22 a. For example, lock 22 a may be disengagedsuch that retractor 18 a may be manually positioned at a desiredlocation relative to the patient, and re-engaged to lock retractor 18 a,and accordingly laparoscopic device 10 coupled thereto, in the desiredposition. As shown in FIG. 1B, second rail-mounted orthopedic retractor18 b having retractor end 20 b may be used during the procedure toengage with and hold another surgical instrument in position uponactuation of lock 22 b. Thus, retractors 18 a and 18 b require extensivemanual interaction with locks 22 a and 22 b, and with retractors 18 aand 18 b themselves, to reposition and lock the respective tools inposition.

The co-manipulation surgical robot systems described herein providesuperior control and stability such that the surgeon and/or assistantmay seamlessly position various off-the-shelf surgical instruments asneeded, thus avoiding the workflow limitations inherent to both humanand mechanical solutions. For example, the robot arms of theco-manipulation surgical robot system may provide surgical assistance byholding a first surgical instrument, e.g., a laparoscope, via a firstrobot arm, and a second surgical instrument, e.g., a retractor, via asecond robot arm, stable throughout the procedure to provide an optimumview of the surgical site and reduce the variability of force applied bythe surgical instruments to the body wall at the trocar point. As willbe understood by a person having ordinary skill in the art, the robotsarms of the co-manipulation surgical robot systems described herein mayhold any surgical instrument, preferably having a long and thininstrument shaft, used for surgical procedures such as laparoscopicprocedures including, e.g., endoscopes/laparoscopes, retractors,graspers, surgical scissors, needle holders, needle drivers, clamps,suturing instruments, cautery tools, staplers, clip appliers, hooks,etc.

The co-manipulation surgical robot system further allows the surgeon toeasily maneuver both tools when necessary, providing superior controland stability over the procedure and overall safety. Any implementationsof the systems described herein enable a surgeon to directlyco-manipulate instruments while remaining sterile at the patientbedside. For example, the system may include two robot arms that may beused by the surgeon to hold both a laparoscope and a retractor. During asurgical procedure, the system may seamlessly reposition eitherinstrument to provide optimal visualization and exposure of the surgicalfield. Both instruments may be directly coupled to the robot arms of thesystem and the system may constantly monitor and record the position ofthe two instruments and/or the two robot arms throughout the procedure.Moreover, the system may record information such as the position andorientation of surgical instruments attached to the robot arms, sensorreadings related to force(s) applied at proximal and distal ends of thesurgical instruments attached to robot arms, force required to hold eachinstrument in position, endoscopic video streams, algorithm parameters,operating room 3D stream captured with an optical scanning device,including, e.g., position(s) of surgical entry port(s), position andmovements of the surgeon's hands, surgical instrument(s) position andorientation, whether or not attached to robot arms, patient position,and patient table orientation and height.

Such data may be used to develop a database of historical data that maybe used to develop the algorithms used in some implementations tocontrol one or more aspects of an operation of the system. In addition,such data may be used during a procedure to control of one or moreaspects of an operation of the system per one or more algorithms of thesystem. For example, the data may be used to assess a level of fatigueof a user of the system as described in U.S. Pat. No. 11,504,197, theentire contents of which is incorporated herein by reference.

As the operator manipulates a robot arm of the co-manipulation surgicalrobot system by applying movement to the surgical instrument coupled tothe robot arm, the system may automatically transition the robot armbetween various operational modes upon determination of predefinedconditions. For example, the system may transition the robot arm to apassive mode responsive to determining that movement of the robot armdue to movement at the handle of the surgical instrument is less than apredetermined amount for at least a predetermined dwell time period,such that in the passive mode, the robot arm maintains a staticposition, e.g., to prevent damage to the equipment and/or injury to thepatient. Additionally, the system may transition the robot arm to aco-manipulation mode responsive to determining that force applied at therobot arm due to force applied at the handle of the surgical instrumentexceeds a predetermined threshold, such that in the co-manipulationmode, the robot arm is permitted to be freely moveable responsive tomovement at the handle of the surgical instrument for performinglaparoscopic surgery using the surgical instrument, while a firstimpedance is applied to the robot arm in the co-manipulation mode toaccount for weight of the surgical instrument and the robot arm.Moreover, the system may transition the robot arm to a haptic moderesponsive to determining that at least a portion of the robot arm isoutside a predefined haptic barrier, such that in the haptic mode, asecond impedance greater than the first impedance is applied to therobot arm, thereby making movement of the robot arm responsive tomovement at the handle of the surgical instrument more viscous in thehaptic mode than in the co-manipulation mode. The system further maytransition the robot arm to a robotic assist mode responsive todetecting various conditions that warrant automated movement of therobot arm to guide the surgical instrument attached thereto, e.g., alonga planned trajectory or to avoid a collision with another object orperson in the surgical space. For example, in an instrument centeringmode of the robotic assist mode, a robot arm coupled to a laparoscopemay automatically move the laparoscope along a planned trajectory totrack an identified surgical instrument and maintain the instrumentwithin the field of view of the laparoscope to provide assistedinstrument centering. As described in further detail below, the systemfurther may transition the robot arm to one or more setup modes formanual and/or automatic reconfiguration of the robot arm to an optimizedposition for a given surgical procedure.

Referring now to FIGS. 2A to 2C, co-manipulation surgical robot system100 is provided. As shown in FIG. 2A, system 100 may include platform200, e.g., a surgical cart, sized and shaped to support one or morerobot arms 300, e.g., robot arm 300 a and robot arm 300 b, each of robotarms 300 having a surgical instrument coupler interface, e.g., couplerinterface 400 a and coupler interface 400 b, for removably coupling to asurgical instrument, and a computing system operatively coupled toplatform 200 and robot arms 300. As shown in FIG. 2A, system 100 furthermay include one or more optical scanners 202, e.g., optical scanner 202a and optical scanner 202 b, for capturing depth data, and graphicaluser interface display 210 for displaying operational information aswell as receiving user input.

As shown in FIG. 2B, platform 200 may include a stage assembly, e.g.,one or more stages coupled to the base portion of one or more robotarms, e.g., base portion 302 a of robot arm 300 a and base portion 302 bof robot arm 300 b, for providing movement to the respective robot arm,e.g., in at least the horizontal and vertical directions relative toplatform 200. Each stage may include vertical extenders, e.g., verticalextender 206 a and vertical extender 206 b, for independently movingrobot arm 300 a and robot arm 300 b, respectively, vertically relativeto platform 200, and horizontal extenders, e.g., horizontal extender 208a and horizontal extender 208 b, for independently moving robot arm 300a and robot arm 300 b, respectively, horizontally relative to platform200, to thereby permit the operator flexibility in positioning robotarms 300 relative to the patient. Accordingly, platform 200 mayindependently move each of robot arm 300 a and robot arm 300 b in anydirection, including a first or vertical direction toward and away fromthe floor (e.g., along the z-axis), and/or a second or horizontaldirection toward and away from the patient (e.g., along the x-axis), asshown in FIG. 2D, and/or a third direction or horizontal direction alonga length of the patient (e.g., along the y-axis). In some embodiments,platform 200 may move robot arm 300 a and robot arm 300 b in the samedirection simultaneously, and further may cause rotational movement ofrobot arm 300 a and robot arm 300 b.

Referring again to FIG. 2A, platform 200 may include a plurality ofwheels 204, e.g., castor wheels, to provide mobility of platform 200,and accordingly, robot arms 300, within the operating room. Wheels 204may each include a braking mechanism which may be actuated to preventmovement of platform 200 via wheels 204. Preferably, wheels 204 may bemanually actuated by an operator to mechanically engage/disengage therespective braking mechanism. For example, as shown in FIG. 2C, platform200 may include locking pedal 211 a configured to be actuated, e.g.,stepped on by a user, to engage the braking mechanism, and unlockingpedal 211 b configured to be actuated, e.g., stepped on by a user, todisengage the braking mechanism. Locking pedal 211 a and unlocking pedal211 b may be configured such that movement of locking pedal 211 a in afirst direction causes movement of unlocking pedal 211 b in a seconddirection opposite to the first, and vice versa.

Additionally or alternatively, wheels 104 may be electrically poweredsuch that they may be actuated to electrically engage/disengage therespective braking mechanism. When ready for operation, platform 200 maybe moved to a desired position at the side of the patient bed and lockedin place via wheels 204, and the vertical and horizontal positions ofrobot arms 300 a and 300 b may be adjusted to an optimum positionrelative to the patient for the procedure via vertical extenders 206 a,206 b and horizontal extenders 208 a, 208 b, responsive to user inputreceived by graphical user interface display 210, and/or via user guidedstage control as described in further detail below. As described infurther detail below, platform 200 may automatically move robot arm 300a and robot arm 300 b responsive to detection of, e.g., potentialcollisions with other objects and/or persons within the operating roomand/or user input applied via the robot arms, during a laparoscopicprocedure and/or during setup of the robot arms.

Moreover, system 100 may include a plurality of depth sensors, e.g.,proximity sensors 212, disposed on platform 100. Proximity sensors 212may be, e.g., a depth camera, a stereo RGB camera, a LIDAR device,and/or an electromagnetic, capacitive, ultrasound, or infrared proximitysensor, etc. For example, a first set of proximity sensors 212 may bepositioned on robot arm 300 a, e.g., at a lower portion of base portion302 a, and a second set of proximity sensors 212 may be positioned onrobot arm 300 b, e.g., at a lower portion of base portion 302 b, tothereby enhance detection of objects approaching the vicinity of robotarms 300 a, 300 b. For example, as shown in FIG. 2E, each base portion302 may include a set of proximity sensors, e.g., forward proximitysensor 212 a for detecting and determining the proximity of objects infront of and around base portion 302 and bottom proximity sensor 212 bfor detecting and determining the proximity of objects in beneath andaround base portion 302. As will be understood by a person havingordinary skill in the art, each base portion may have less or more thantwo proximity sensors. In some embodiments, proximity sensors 212 mayonly be active during movement of the stages of platform 200, asdescribed in further detail below, and when the system is unlocked.Alternatively, proximity sensors 212 may be active during movement ofplatform 200, e.g., when the braking mechanism of wheels 204 aredisengaged.

As base portions 302 a, 302 b are generally lower than the more distalcomponents of robot arms 300 a, 300 b, they may be more prone tocollision with, e.g., the patient bed, as the stages of platform 200move robot arms 300 a, 300 b horizontally and vertically relative toplatform 200. Accordingly, the system may generate an alert, e.g., viaindicators 334 as described in further detail below, when the proximitysensors detect that the proximity between the robot arms and one or moreobjects within the operating room falls below a predetermined distancethreshold. For example, indicators 334 may illuminate in a predeterminedcolor and/or pattern, e.g., blinking, to indicate proximity with the oneor more objects, and the frequency of the blinking may increase as theproximity gets closer. Moreover, the system may cause the stage assemblyof platform 200 to stop movement of robot arms relative to platform 200when the proximity between the robot arms and the one or more objectswithin the operating room falls below the predetermined distancethreshold. In addition, the system further may display, e.g., via GUI210, an indication that an object is within a predetermined proximity ofthe robot arm, as determined by forward proximity sensors 212 a and/orbottom proximity sensors 212 b.

Surgical robot system 100 is configured for co-manipulation, such thatsystem 100 may assist the user or operator, e.g., a surgeon and/orsurgical assistant, by permitting the user to freely move robot arm 300a and/or robot arm 300 b due to manipulation of one or more surgicalinstruments coupled with the robot arms in response to force applied bythe user to the surgical instruments. Accordingly, system 100 may beconfigured so that it is not controlled remotely, such that robot arms300 move directly responsive to movement of the surgical instrumentcoupled thereto by the operator, while compensating for the mass of thesurgical instrument and of the respective robot arm and providinglocalized impedance along the robot arm, thereby increasing the accuracyof the movements or actions of the operator as the operator manipulatesthe surgical instrument.

System 100 may be particularly useful in laparoscopic surgicalprocedures and/or other surgical procedures that utilize long and thininstruments that may be inserted, e.g., via cannulas, into the body of apatient to allow surgical intervention. As will be understood by aperson having ordinary skill in the art, system 100 may be used for anydesired or suitable surgical operation. Moreover, system 100 may be usedin conjunction or cooperation with video monitoring provided by one ormore cameras and/or one or more endoscopes so that an operator of system100 may view and monitor the use of the instrument coupled with robotarms 300 a, 300 b via respective coupler interfaces 400 a, 400 b. Forexample, robot arm 300 a may be removeably coupled with and manipulatean endoscope, while robot arm 300 b may be may be removeably coupledwith and manipulate a surgical instrument.

As shown in FIGS. 2A and 2B, system 100 further may include one or moreoptical scanners 200, e.g., optical scanners 202 a, 200 b, e.g., a LiDARscanner or other suitable optical scanning device such as an RGBD cameraor sensor, RGB camera with machine learning, a time-of-flight depthcamera, structured light, multiple projection cameras, a stereo camera,ultrasound sensors, laser scanner, other type of coordinate measuringarea scanner, or any combination of the foregoing, for providing a videostream of the surgical scene, e.g., via streaming, for monitoring andanalysis. For example, the LiDAR camera/scanner may be capable ofrecording both color (RGB) and the Depth (D) of the surgical field, andmay include, for example, an Intel RealSense LiDAR Camera L515 or anIntel RealSense Depth Camera D435i (made available by Intel, SantaClara, California) or other LiDAR or depth cameras having similar orsuitable specifications including, without limitation, any of thefollowing specifications: (i) range: 25 cm to 500 cm; depth accuracy: 5mm or approximately 5 mm; depth field of view: 70×55 or approximately70×55 (degrees); depth output resolution: 1024×768 pixels orapproximately 1024×768 pixels; depth/RGB frame rate: 30 frames persecond; RGB frame resolution: 1920×1080; and/or RGB field of view: 70×43degrees or approximately 70×43 degrees. The LiDAR scanner or opticalscanner further may include both a ¼-20 UNC thread or 2× M3 threadmounting points.

Optical scanners 202, and any other electronics, wiring, or othercomponents of the system, may be supported via platform 200 such thatoptical scanners 202 are mounted in a fixed location relative to theother objects in the surgical space, and the position and orientation ofoptical scanners 202 are known or may be determined with respect to theglobal coordinate system of the system, and accordingly, the robot arms.This allows all data streams to be transformed into a single coordinatesystem for development purposes. Moreover, telemetry data captured byoptical scanners 202, e.g., indicative of the movements of the surgeon'shands, other body parts, the patient bed, the cut-out in a sterile drapeover the patient on the surgical bed, the exposed skin through thecut-out in the sterile drape, the trocar(s), the surgical instruments,and other components of the system, may be recorded to provide a richand detailed dataset describing the precise movements and forces appliedby the surgeon throughout the procedure.

As shown in FIG. 2B, a first optical scanner, e.g., optical scanner 202a, may be supported on an upper portion of platform 200, e.g., vialighthouse 203, and may be adjusted, e.g., up/down, in/out, right/left,to adjust the field of view of optical scanner 202 a to allow opticalscanner 202 a to gain an optimum field of view or position relative tothe other components of the system, for example, robot arms 300 a, 300b, the surgical instruments attached thereto, the surgeon, and/orsurgical assistant. For example, optical scanner 202 a may collect depthdata indicative of, e.g., the height of the surgical bed, the angle ofthe surgical bed (cranial to caudal, and medial to lateral), the planeof the surgical bed, the cranial end of the surgical bed, the positionand orientation of the surgical bed, the location of one or more trocarports, movement of a surgical instrument coupled to the distal end ofthe robot arm, movement of a handheld surgical instrument not coupled tothe robot arm, e.g., held by a user, attachment and detachment of asurgical instrument to the distal end of the robot arm, etc.

As shown in FIG. 2B, lighthouse 203 may include indicator 334, e.g., anLED ring, disposed thereon for displaying visual alerts, as described infurther detail below. In addition, system 100 may include one or morerobot arm markers, e.g., markers 205, configured to indicate which robotarm, e.g., robot arm 300 a, 300 b, is in operation/active. For example,markers 205 may include a visual representation associated with eachrobot arm, e.g., Roman numeral I associated with robot arm 300 a andRoman numeral II associated with robot arm 300 b, each of which mayilluminate to indicate that the respective robot arm is in operation,e.g., being moved by the operator and/or system. Markers 205 may bedisposed on the front side of lighthouse 203, as shown in FIG. 2B, andfurther may be disposed on, e.g., the rear side of lighthouse 203 and/oron power button panel 207, as shown in FIG. 2C, such that markers 205may be visible to a user standing behind platform 200. As shown in FIG.2B, lighthouse 203 further may include drape hook 209, e.g., belowmarkers 205 on the front side of lighthouse 203, sized and shaped tosupport a sterile drape, as described in further detail below withregard to FIG. 10F.

As shown in FIG. 2B, a second optical scanner, e.g., optical scanner 202b, may be supported on a lower portion of platform 200 to allow opticalscanner 202 b to provide the system a more complete field of view of theoperating room that may not be captured by first optical scanner 202 a,e.g., the patient table and objects on the floor of the operating roomsuch as electrical cables. For example, optical scanner 202 a maycollect depth data indicative of, e.g., the distance/proximity betweensystem 100 and a surgical bed, the relative angle between system 100 andthe surgical bed, closest feature on and edge of the surgical bed, thecranial and caudal ends of the surgical bed, one or more objects/personsbetween system 100 and the surgical bed, one or more objects/persons onthe other side of the surgical bed, etc. As will be understood by aperson having ordinary skill in the art, more than two optical scannersmay be used to further enhance the field of view of the system.

The data obtained by the optical scanners may be used to optimize theprocedures performed by the system including, e.g., automatic servoing(i.e., moving) of one or more portions of robot arms 300. By trackingthe tendency of the surgeon to keep the tools in a particular region ofinterest and/or the tendency of the surgeon to avoid moving the toolsinto a particular region of interest, the system may optimize theautomatic servoing algorithm to provide more stability in the particularregion of interest. In addition, the data obtained may be used tooptimize the procedures performed by the system including, e.g.,automatic re-centering of the field of view of the optical scanningdevices of the system. For example, if the system detects that thesurgeon has moved or predicts that the surgeon might move out of thefield of view, the system may cause the robot arm supporting the opticalscanning device, e.g., a laparoscope, to automatically adjust thelaparoscope to track the desired location of the image as the surgeonperforms the desired procedure, as described in further detail below.This behavior may be surgeon-specific and may require an understandingof a particular surgeon's preference for an operating region ofinterest. Additionally or alternatively, this behavior may beprocedure-specific. Thus, the system may control the robot arms pursuantto specific operating requirements and/or preferences of a particularsurgeon. Moreover, if the system detects that the robot arms are in anextended position for a period of time exceeding a predeterminedthreshold, the system may cause the stages coupled to the base portionsof the robot arms to move the robot arms in a manner to ease extensionof the robot arms, and thereby provide additional range for extension ofthe robot arms by the user.

Referring now to FIG. 3 , a surgical support arm is provided. Asdescribed above, system 100 may include a plurality of robot arms, e.g.,robot arm 300 a and robot arm 300 b; however, as each robot arm may beconstructed identically, only a single robot arm, e.g., robot arm 300,is described with regard to FIG. 3 for brevity, collectively as robotarm 300. Aspects of the robot arms described herein may utilizestructures from U.S. Pat. No. 10,118,289 to Louveau, U.S. Pat. No.11,504,197 to Noonan, U.S. Pat. No. 11,622,826 to Basafa, and U.S.Patent Appl. Pub. No. 2023/0114137 to Wu, the entire contents of each ofwhich are incorporated herein by reference. Robot arm 300 may include aplurality of arm segments/links and a plurality of articulation jointsextending from a base portion. For example, robot arm 300 may include abase portion, a shoulder portion, an elbow portion, and a wrist portion,thereby mimicking the kinematics of a human arm. As shown in FIG. 3 ,robot arm 300 may include a base, which includes base portion 302rotatably coupled to shoulder portion 304 at base joint 303. Forexample, shoulder portion 304 may sit on top of base portion 302, andmay be rotated relative to base portion 302 about axis Q1 at base joint303. In some embodiments, robot arm 300 may be interchanged, swapped, orcoupled with the base in any desired arrangement.

Robot arm 300 further may include shoulder link 305, which includesproximal shoulder link 306 rotatably coupled to distal shoulder link308. A proximal end of proximal shoulder link 306 may be rotatablycoupled to shoulder portion 304 of the base at shoulder joint 318, suchthat proximal shoulder link 306 may be rotated relative to shoulderportion 304 about axis Q2 at shoulder joint 318. As shown in FIG. 3 ,axis Q2 may be perpendicular to axis Q1. The distal end of proximalshoulder link 306 may be rotatably coupled to the proximal end of distalshoulder link 308 at joint 320, such that distal shoulder link 308 maybe rotated relative to proximal shoulder link 306 about axis Q3 at joint320. As shown in FIG. 3 , axis Q3 may be parallel to the longitudinalaxis of shoulder link 305.

In addition, robot arm 300 may include actuator 330, e.g., a collar,lever, button, or switch, operatively coupled to a motor operativelycoupled to distal shoulder link 308 and/or proximal shoulder link 306 atjoint 320, such that distal shoulder link 308 may only be rotatedrelative to proximal should link 306 upon actuation of actuator 330.Actuator 330 may be configured to permit dual actuation, e.g., a firstactuation to cause distal shoulder link 308 to rotate in a firstdirection relative to shoulder link 306, and a second actuation to causedistal shoulder link 308 to rotate in a second direction opposite to thefirst direction. For example, as shown in FIG. 3 , actuator 330 may be acollar rotatably coupled to a link of robot arm 300, e.g., elbow link310 described below, such that rotation of collar 330 in a firstdirection about the longitudinal axis of link 310 causes distal shoulderlink 308 to rotate in a corresponding first direction relative toproximal shoulder link 306, and rotation of collar 330 in a seconddirection about the longitudinal axis of link 310 opposite to the firstdirection causes distal shoulder link 308 to rotate in a correspondingsecond direction relative to proximal shoulder link 306 opposite to thecorresponding first direction.

As shown in FIG. 3 , collar 330 may include setup mode actuator 336disposed thereon, e.g., a button, which the system may require to beactuated to permit a rotation of collar 330 to cause a correspondingrotation of distal shoulder link 308 relative to proximal shoulder link306. For example, the user may be required to actuate setup actuator 336to switch the system to the user guided setup mode, and maintain setupactuator 336 in an actuated state while collar 330 is rotated to cause acorresponding rotation of distal shoulder link 308 relative to proximalshoulder link 306. In addition, collar 330 may be spring-enforced suchthat upon release of collar 330 in any position, collar 330 returns to aneutral position relative to link 310 whereby distal shoulder link 308does not rotate relative to proximal shoulder link 306. Alternatively oradditionally, instead of actuating collar 330 to cause rotation ofdistal shoulder link 308 relative to proximal shoulder link 306, in someembodiments, upon actuation of setup actuator 336, application of aforce to the distal end of the robot arm, e.g., a left/right force, maycause distal shoulder link 308 to rotate in a corresponding directionrelative to proximal shoulder link 306. Distal shoulder link 308 maycontinue to be rotated relative to proximal shoulder link 306 until theapplied force is released and/or a counter force in an oppositedirection is applied to the distal end of the robot arm, and/or until amaximum rotation is reached.

Accordingly, axis Q3 may be a “setup” axis, such distal shoulder link308 may be rotated and fixed relative to proximal shoulder link 306during a setup stage prior to an operating stage where robot arm 300 isused in a surgical procedure, as described in further detail with regardto FIGS. 11A to 11D. In addition, the system may switch between theoperating stage and the setup stage during a surgical procedure topermit reconfiguration of the robot arm via the setup joints as needed.When actuator 330 is in an unactuated state, setup joint 320 preventsrelative movement between distal shoulder link 308 and proximal shoulderlink 306, such that distal shoulder link 308 is fixed relative toproximal shoulder link 306. Upon actuation of actuator 330, distalshoulder link 308 may be automatically rotated relative to proximalshoulder link 306 until actuator 330 is released. Alternatively,actuator 330 may be operatively coupled to distal shoulder link 308and/or proximal shoulder link 306, such that upon actuation of actuator330, distal shoulder link 308 may be manually rotated in predefinedincrements relative to proximal shoulder link 306.

Robot arm 300 further may include elbow link 310. A proximal end ofelbow link 310 may be rotatably coupled to a distal end of distalshoulder link 308 at elbow joint 322, such that elbow link 310 may berotated relative to distal shoulder link 308 about axis Q4 at elbowjoint 322. Robot arm 300 further may include wrist portion 311, whichmay include proximal wrist link 312 rotatably coupled to the distal endof elbow link 310 at wrist joint 324, middle wrist link 314 rotatablycoupled to proximal wrist link 312 at joint 326, and distal wrist link316 coupled to/extending from middle wrist link 314, which may berotatably coupled to surgical instrument coupler interface 400 (notshown) at joint 328, as further shown in FIGS. 5A and 5B. Accordingly,wrist portion 311 may be rotated relative to elbow link 310 about axisQ5 at wrist joint 324, middle wrist portion 314 may be rotated relativeto proximal wrist link 312 about axis Q6 at joint 326, and surgicalinstrument coupler interface 400 may be rotated relative to distal wristlink 316, and accordingly middle wrist link 314, about axis Q7 at joint328.

Referring again to FIG. 3 , robot arm 300 may include actuator 332,e.g., a lever, button, or switch, operatively coupled to elbow link 310and/or proximal wrist link 312 at joint 324, such that proximal wristlink 312 may only be rotated relative to elbow link 310 upon actuationof actuator 332. Accordingly, axis Q5 may be a “setup” axis, suchproximal wrist link 312 may be rotated and fixed relative to elbow link310 during a setup stage, upon actuation of actuator 332, prior to theoperating stage where robot arm 300 is used in a surgical procedure.When actuator 332 is in an unactuated state, setup joint 324 preventsrelative movement between proximal wrist link 312 and elbow link 310,such that proximal wrist link 312 is fixed relative to elbow link 310.In some preferred embodiments, upon actuation of actuator 332, proximalwrist link 312 may be manually rotated in predefined increments relativeto elbow link 310, thereby removing the necessity of having additionalmotors and/or electronics at the distal region of robot arm 300.Alternatively, upon actuation of actuator 332, proximal wrist link 312may be automatically rotated relative to elbow link 310 until actuator332 is released, e.g., via a motor operatively coupled to proximal wristlink 312 and/or elbow link 310 at joint 324.

As shown in FIG. 3 , robot arm 300 may include a plurality of motors,e.g., motors M1, M2, M3, which may all be disposed within the base ofrobot arm 300, and M4, which preferably may be disposed adjacent tojoint 320. Alternatively, motor M4 also may be disposed within the baseof robot arm 300. Each of motors M1, M2, M3, may be operatively coupledto a respective motorized joint of robot arm 300, e.g., base joint 303,shoulder joint 318, and elbow joint 322, to thereby apply a localizedimpedance at the respective joint. For example, motors M1, M2, M3 mayproduce an impedance/torque at any of base joint 303, shoulder joint318, and elbow joint 322, respectively, to thereby effectively apply animpedance at the distal end of robot arm, e.g., at the attachment pointwith the surgical instrument, to improve the sensations experienced bythe operator during manipulation of the surgical instrument as well asthe actions of the operator during surgical procedures. For example,impedance may be applied to the distal end of robot arm 300, andaccordingly the surgical instrument coupled thereto, to provide asensation of a viscosity, a stiffness, and/or an inertia to the operatormanipulating the surgical instrument. Moreover, applied impedances maysimulate a tissue density or stiffness, communicate surgical boundariesto the operator, and may be used to direct a surgical instrument along adesired path, or otherwise. In some embodiments, the motors may actuatethe respective joints to thereby cause movement of robot arm 300 aboutthe respective joints. Accordingly, axis Q1, axis Q2, and axis Q4 mayeach be a “motorized” axis, such that motors M1, M2, M3 may apply animpedance/torque to base joint 303, shoulder joint 318, and elbow joint322, respectively, to inhibit or actuate rotation about the respectiveaxis. As described in further detail below, motors M1, M2, M3 may becontrolled by a processor of the co-manipulation robot platform. Withthree motorized axes, some implementations of robot arm 300 may applyforce/torque at the distal end of robot arm 300 in three directions tothereby move the surgical instrument coupled to the distal end of robotarm 300 in three degrees of freedom.

Motor M4 may be operatively coupled to setup joint 320 to thereby applya torque to joint 320 to actuate rotation of distal shoulder link 308relative to proximal shoulder link 306 about axis Q3. Unlike the othermotorized joints described herein, e.g., base joint 303, shoulder joint318, and elbow joint 322, motorized joint 320 is preferably not“back-drivable,” in that the user cannot actuate motorized joint 320,e.g., via movement of the surgical instrument coupled to the robot armwhen the system is in co-manipulation mode. Instead, as described above,actuation of motorized joint 320 may be conducted via one or moreactuators, e.g., actuator 330 and/or an actuator displayed on GUI 210,that may be actuated to automatically cause rotation of distal shoulderlink 308 relative to proximal shoulder link 306.

Axis Q6 and axis Q7 may each be a “passive” axis, such that middle wristlink 314 may be rotated relative to proximal wrist link 312 at passivejoint 326 without any applied impedance from system 100, and surgicalinstrument coupler interface 400 may be rotated relative to distal wristlink 316 at passive joint 328 without any applied impedance from system100. The distal end of distal wrist link 316 may be rotatably coupled tosurgical instrument coupler interface 400 for removably coupling with asurgical instrument, e.g., via coupler body 500 as shown in FIGS. 5A and5B, which may be removeably coupled to the surgical instrument and tocoupler interface 400, as described in further detail below.Alternatively, wrist portion 311 may include a passive ball joint at theattachment point with the surgical instrument, as described in U.S. Pat.No. 10,582,977, the entire disclosure of which is incorporated herein byreference.

Referring again to FIG. 3 , robot arm 300 further may include aplurality of encoders, e.g., encoders E1-E7, disposed on at least someof the plurality of joints of robot arm 300. For example, encoder E1 formeasuring angulation between base portion 302 and shoulder portion 304may be disposed on or adjacent to base joint 303 within the base,encoder E2 for measuring angulation between shoulder portion 304 andproximal shoulder link 306 may be disposed on or adjacent to shoulderjoint 318 within the base, encoder E3 for measuring angular rotationbetween proximal shoulder link 306 and distal shoulder link 308 may bedisposed on or adjacent to joint 320, encoder E4 for measuringangulation between distal shoulder link 308 and elbow link 310 may bedisposed adjacent to motor M3 operatively coupled to elbow joint 322within the base as transmission of rotational motion at elbow joint 322is achieved via a connection rod extending from the base to elbow joint322, encoder E5 for measuring angular rotation between elbow link 310and proximal wrist link 312 may be disposed on or adjacent to wristjoint 324, encoder E6 for measuring angulation between proximal wristlink 312 and middle wrist link 314 may be disposed on or adjacent tojoint 326, and encoder E7 for measuring angulation of between distalwrist link 316 and surgical instrument coupler interface 400 may bedisposed on or adjacent to joint 328. Alternatively, encoder E4 may bedisposed on or adjacent to elbow joint 322. The encoders may be absoluteencoders or other position/angulation sensors configured to generatedata for accurately determining the position and/or angulation ofcorresponding links at the respective joint and/or the exact position ofthe surgical instrument coupled to the distal end of robot arm 300.Accordingly, the exact position of each link, joint, and the distal endof robot 300 may be determined based on measurements obtained from theplurality of encoders. Preferably, a redundant encoder is disposed ateach location along robot arm 300 where an encoder is placed, to providemore accurate position data, as well as, to detect a fault condition, asdescribed in further detail below.

Prior to attachment with a surgical instrument, robot arm 300 may bemanually manipulated by a user, e.g., to position robot arm 300 is adesired position for coupling with the surgical instrument. For example,the user may manually manipulate robot arm 300 via wrist portion 311,actuator 330, and/or actuator 332. Upon actuation of actuator 330, theuser may automatically rotate distal shoulder link 308, and uponactuation of actuator 332, the user may manually manipulate proximalwrist portion 312. Moreover, robot arm 300 may further be manually movedby application of a force directly on the other links and/or joints ofrobot arm 300.

In some embodiments, in a user guided setup mode, responsive to forceapplied to a distal region of robot arm 300, e.g., at any locationdistal to Q4 such as at wrist portion 311, wrist joint 324, elbow link310, the surgical instrument, etc., by the user, e.g., exceeding apredetermined force threshold or in a predetermined pattern, in a givendirection, e.g., in/out and/or up/down, the processor of theco-manipulation robot platform may cause the stages of platform 200coupled to base portion 302 of robot arm 300 to move robot arm 300 inthe same/corresponding direction, e.g., via vertical extenders 206 a,206 b and horizontal extenders 208 a, 208 b, until the force applied torobot arm 300 by the user is detected by the system to drop below apredetermined threshold, e.g., when the user releases robot arm 300. Dueto the lever arm effect, forces applied to robot arm 300 farther from Q4will be greater than forces applied closer to Q4, and therefore may bepreferable during user guided setup mode to move the stages of platform200. In some embodiments, the system may cause movement of the base ofthe robot arm via the stage assembly upon application of force at thedistal region of the robot arm in the user guided setup mode at avelocity corresponding to the amount of force applied at the distalregion of the robot arm. Accordingly, the velocity of movement of thestage assembly may be controlled by adjusting the amount of forceapplied to the distal region of the robot arm in the user guided setupmode, and further may slow down as the stage assembly reaches or nearsits maximum extension range.

As described above, in some embodiments, the processor of theco-manipulation robot platform also may cause the distal shoulder linkto rotate relative to the proximal shoulder link responsive to forceapplied to the distal region of robot arm 300 by the user, e.g.,exceeding a predetermined force threshold or in a predetermined pattern,in a given direction, e.g., left/right. In some embodiments, the systemmay stop movement of robot arm 300 in the same direction as the forceapplied by the user when the user applies a counter force to robot arm300, e.g., in a direction opposite to the direction of movement of robotarm 300, to facilitate setup of robot arm 300 relative to the patient.This feature may be initiated/stopped via user actuation, e.g., byactuating actuator 336 on collar 330, voice command, etc. In a preferredembodiment, the system only switches to the user guided setup mode whenactuator 336 is in an actuated state, e.g., actively being pressed by auser. Accordingly, the user may actuate actuator 336 with one hand,while simultaneously applying force to the distal region of the robotarm with the other hand to cause movement of the stages of platform 200while actuator 336 is actuated.

For example, upon actuation of the user guided setup mode, the user mayapply a force that exceeds a predetermined force threshold on wristportion 311 in a first direction, e.g., by applying a pulling or pushingforce, which causes the stages of platform 200 to move robot arm 300 inthat same direction until the user stops movement of wrist portion 311,e.g., by letting go of robot arm 300 or by applying a counter force torobot arm 300, and/or a maximum extension of the stage assembly isreached, such that the system stops movement of the stages of platform200. For example, a subsequent pushing force may be counter to aninitial pulling force, and a subsequent pulling force may be counter toan initial pushing force. Moreover, the stages of platform 200 may stopmoving robot arm 300 when force applied at the distal region of robotarm 300 falls below a predetermined release threshold, which may includeletting go of robot arm 300. Accordingly, force applied at the distalregion of the robot arm, e.g., wrist portion 311, wrist joint 324, elbowlink 310, etc., may serve as an input for motion generated in particulardirections of the robot arms via the stages coupled thereto. Suchautomated movement of the stages of platform 200 responsive to forceapplied to the distal end of robot arm 300 by the user may be limited towhen the system is in a predefined operating mode, e.g., a user guidedsetup mode, which may be entered in during setup and/or during asurgical procedure, e.g., upon actuation of actuator 336, GUI 210,and/or via voice control.

Similarly, when the user applies a counter force exceeding apredetermined threshold in a predefined direction distinct from thedirections that cause horizontal (x-axis) and vertical (z-axis) movementof the stages of platform 200, the system may automatically actuatemotorized joint 320 to cause rotation of distal shoulder link 308relative to proximal shoulder link 306 to facilitate movement of robotarm 300 in the predefined direction. For example, similar to how thesystem may cause the stages of platform 200 to move robot arm 300responsive to movement of the distal region of robot arm 300 by theuser, e.g., back/forth along the x-axis or up/down along the z-axis, asdescribed above, the system may cause motorized joint 320 to rotatedistal shoulder link 308 relative to proximal shoulder link 306 to moverobot arm 300 along the y-axis responsive to movement of the distal endof robot arm 300 by the user along the y-axis. Accordingly, the systemmay stop actuation of motorized joint 320 when the force applied by theuser to the distal region of robot arm 300 drops below a predeterminedthreshold. M4 may be controlled by a processor of the co-manipulationrobot platform.

Upon attachment to the surgical instrument, robot arm 300 may still bemanipulated manually by the user exerting force, e.g., one or morelinear forces and/or one or more torques, directly to robot arm 300;however, during the laparoscopic procedure, the operator preferablymanipulates robot arm 300 only via the handle of the surgicalinstrument, which applies force/torque to the distal end of the robotarm 300, and accordingly the links and joints of robot arm 300. As theoperator applies a force to the surgical instrument attached to robotarm 300, thereby causing movement of the surgical instrument, robot arm300 will move responsive to the movement of the surgical instrument toprovide the operator the ability to freely move surgical instrumentrelative to the patient. As described in further detail below, robot arm300 may apply an impedance to account for weight of the surgicalinstrument and of robot arm 300 itself, e.g., gravity compensation, asthe operator moves the surgical instrument, thereby making it easier forthe operator to move the instrument despite gravitational forces and/orinertial forces being exerted on the robot arm and/or the surgicalinstrument. As will be understood by a person having ordinary skill inthe art, robot arm 300 may include less or more articulation joints thanis shown in FIG. 3 , as well as a corresponding number of motors andencoders/sensors.

In addition, each of robot arms 300 further may include indicators 334for visually indicating the operational mode associated with therespective robot arm in real-time. For example, indicators 334 may bepositioned on at least elbow link 310 of the robot arm, e.g., adjacentto elbow joint 322, as shown in FIG. 3 . Additionally or alternatively,indicators 334 may be placed elsewhere on system 200, e.g., on shoulderportion 304, on shoulder link 305, on platform 200, on lighthouse 203,on display 210, etc. For example, as shown in FIG. 4 , which illustratesan alternative pair of robot arms, e.g., 300 a′ and 300 b′, which may beconstructed similarly to robot arms 300 a and 300 b, with similarcomponents having like-prime reference numerals, indicators 334 a′, 334b′ may be disposed on shoulder portion 304 a′, 304 b′ of the base ofrobot arms 300 a′, 300 b′ and/or on elbow link 310 a′, 310 b′, e.g.,adjacent to the respective elbow joints. In some embodiments, the statusof the system conveyed by the indicator on lighthouse 203 may bedifferent from the status of the system/robot arms conveyed by theindicators elsewhere on the system, e.g., on the shoulder portion, onthe base portion, on the elbow link, etc. For example, the indicator onlighthouse 203 may be programmed to illuminate in a predetermined amountof colors that is less than the predetermined amount of colorsilluminated by the other indicators of the system, to thereby conveypredetermined statuses of the overall system, whereas the otherindicators of the system may be illuminated in various colors to conveyspecific statuses of the system and the robot arm, e.g., when a coupleris mounted on the robot arm, the current operational mode of the robotarm, etc.

Moreover, indicators 334, 334 a′, 334 b′ may include lights, e.g., LEDlights, that may illuminate in a variety of distinct colors and indistinct patterns, e.g., solid on or blinking. For example, eachoperational mode of system 100 may be associated with a uniquely coloredlight, such as red, yellow, blue, green, purple, white, orange, etc., asdescribed in, for example, U.S. Pat. No. 11,504,197, the contents ofwhich are incorporated herein by reference. Accordingly, indicators 334,334 a′, 334 b′ may indicate a transition from one operational mode toanother operational mode. Additionally or alternatively, transitionsfrom one operational mode to another operational mode may be indicatedto a user via haptic feedback, e.g., a vibration delivered to the distalend of the robot arm, and accordingly to the surgical instrument coupledthereto. For example, the distal end of the robot arm may vibrate as therobot arm transitions from co-manipulation mode to static mode to assurethe user that the robot arm is in static/passive mode and will remain inposition upon release by the user and/or after the system identifies ahold as part of the instrument detection phase of the instrumentcentering mode described below. Additionally or alternatively, anaudible alert may be emitted to indicate to the user when the robot armtransitions from one operational mode to another operational mode.

Referring now to FIGS. 5A and 5B, a close-up view of the couplingmechanism of coupler interface 400 and coupler body 500 is provided. Thecoupling mechanism may be constructed as described in U.S. Patent Appl.Pub. No. 2023/0114137. For example, the coupling mechanism may includecoupler interface 400 at the distal end of the distal-most link of therobot arm (illustratively, link 316), and coupler body 500, which may beconfigured to be removably coupled to a surgical instrument and tocoupler interface 400, such that a sterile drape may be placed betweencoupler interface 400 and coupler body 500. Accordingly, coupler body500 may be disposable, or alternatively, sterilizeable between surgicalprocedures. Moreover, the coupling mechanism may be operatively coupledto one or more sensors for detecting when coupler body 500 is coupled tocoupler interface 400, and when a surgical instrument is coupled tocoupler body 500 when coupler body 500 is coupled to coupler interface400, as well as the type/size/make of the surgical instrument coupled tocoupler body 500, as described in further detail below.

FIG. 6 illustrate coupler interface 400 at the distal end of link 316 ofthe robot arm. As shown in FIG. 6 , coupler interface 400 may includeprotrusion 404 extending from flat portion 402. Flat portion 402 mayhave an outer diameter that coincides with the outer diameter of link316. Protrusion 404 may have a non-circular profile, which correspondsto the geometry of groove 505 of coupler body 500, as described infurther detail below. Moreover, protrusion 404 may include one or morelocking portions 406 disposed on the outer surface of the sidewall ofprotrusion 404. For example, locking portions 406 may beindentations/grooves extending along the outer surface of protrusion404, and sized and shaped to engage with locking arms 506 of couplerbody 500, as described in further detail below, for securing couplerbody 500 to coupler interface 400, and for securing the sterile drapebetween coupler body 500 and coupler interface 400. Preferably,protrusion 404 includes at least a pair of locking portions 406, suchthat coupler body 500 may be securely coupled to coupler interface 400in two orientations.

Moreover, coupler interface 400 may include an extended portionconfigured to be inserted within link 316. Coupler interface 400 may berotatably coupled to the distal end of distal wrist link 316 using anysuitable fasteners or connectors, e.g., magnets, screws, pins, clamps,welds, adhesive, rivets, and/or any other suitable faster or anycombination of the foregoing. In addition, as described in U.S. PatentAppl. Pub. No. 2023/0114137, coupler interface 400 may include arepulsion magnet disposed within protrusion 404. The repulsion magnet isconfigured to apply a magnetic force to a magnet slidably disposedwithin coupler body 500 to facilitate determination of when coupler body500 is coupled to coupler interface 400 and no surgical instrument iscoupled to coupler body 500, e.g., by causing the magnet to move to aposition within coupler body 500 with a maximum distance from couplerinterface 400, and/or to facilitate coupling of the surgical instrumentto coupler body 500, as described in further detail below. Moreover, asdescribed above, robot arm 300 may include one or more encoders E7 formeasuring angulation of between distal wrist link 316 and surgicalinstrument coupler interface 400 may be disposed on or adjacent to joint328, e.g., within link 316. For example, encoders E7 may include two ormore encoders positioned circumferentially around the extended portionof coupler interface 400.

Referring now to 7A to 7C, coupler body 500 is provided. Coupler body500 may be configured to be removably coupled to a surgical instrumenthaving a predefined shaft diameter, e.g., a 10 mm surgical instrument.Coupler body 500 is preferably designed to be locked to the distal endof the robot arm with a sterile drape therebetween such that the robotarm remains covered and sterile throughout a procedure. Further, couplerbody 500 also has a separate portion for locking to a surgicalinstrument (e.g., a commercially available laparoscopic instrument) topermit the clinician to perform the surgeries with the robot arm(s) asdescribed herein. As shown in FIGS. 7A to 7C, coupler body 500 mayinclude coupler interface connection portion 504 and surgical instrumentconnection portion 502. As shown in FIG. 7C, coupler interfaceconnection portion 504 may include groove 505 extending inward from abottom surface of coupler body 500. Groove 505 may have a geometry thatcorresponds with the profile shape of protrusion 404 of couplerinterface 400, such that protrusion 404 may be received by groove 505while limiting rotational movement between coupler body 500 and couplerinterface 400. The sterile drape may be positioned between protrusion404 and groove 505 when protrusion 404 is disposed within groove 505.Preferably, the profile of protrusion 404 and the corresponding geometryof groove 505 are symmetrical such that protrusion 404 may be receivedby groove 505 in at least two orientations. For example, in someembodiments, the profiles of protrusion 404 and groove 505 may comprisea diamond, rectangular, or oval shape. Moreover, the profile ofprotrusion 404 and the corresponding geometry of groove 505 may guidethe coupling of coupler body 500 to coupler interface 400 by the user.

Additionally, coupler interface connection portion 504 may include apair of locking arms 506 configured to facilitate securing of couplerbody 500 to coupler interface 400 when protrusion 404 is disposed withingroove 505. Each of locking arms 506 may include handle portion 510sized and shaped to be actuated by the user's fingers, and connectionportion 508 sized and shaped to engage with locking portions 406 ofprotrusion 404. For example, connection portion 508 may have a taperedprofile for securely engaging with locking portion 406. Locking arms 506may be pivotally coupled to coupler interface connection portion 504,such that locking arms 506 may be transitionable between an unlockedstate and a locked state. Moreover, locking arms 506 may be pivotallycoupled to coupler interface connection portion 504 via a spring, e.g.,a torsion spring, an extension spring, a compression spring, etc., suchthat locking arms 506 are biased toward the locked state. Accordingly,handle 510 may be actuated to transition locking arms 506 from thelocked state to the unlocked state.

Accordingly, prior to coupling coupler body 500 to coupler interface400, a sterile drape may be positioned between coupler body 500 andcoupler interface 400, such that the sterile drape may be draped overrobot arm 300, as described above. Moreover, an elastic band of thesterile drape may be hooked onto a hook disposed on lighthouse 203 tosecure the drape over lighthouse 203. The sterile drape may be markedand secured with, e.g., peel-off labels, to facilitate efficientapplication of the drape. The user may then apply a force to handleportions 510 of locking arms 506, e.g., pinch handle portions 510 towardeach other, to thereby cause connection portions 508 to move away fromeach other towards the unlocked state and out of groove 505, and provideclearance for protrusion 404 to be received within groove 505. Whenlocking arms 506 are in their unlocked state, coupler body 500 may becoupled to coupler interface 400 such that protrusion 404 is disposedwithin groove 505. Once protrusion 404 is disposed within groove 505,the user may release handle portions 510, such that locking arms 506move back towards their locked state and connection portion 508 engageswith locking portion 406 of protrusion 406. Accordingly, the engagementof connection portion 508 and locking portion 406 due to thecorresponding geometries of connection portion 508 and locking portion406 may prevent movement between coupler body 500 and coupler interface400, to thereby securely couple coupler body 500 to coupler interface400.

As shown in FIGS. 7A to 7C, surgical instrument connection portion 502may include opening 516 extending therethrough, sized and shaped toreceive the shaft of a surgical instrument. For example, opening 516 maybe sized and shaped to receive a 10 mm surgical instrument shaft.Opening 516 may be defined by a channel extending downward from an uppersurface of surgical instrument connection portion 502 such that asurgical instrument may be inserted into opening 516 via the channel. Asshown in FIGS. 7A and 7B, the upper surface of surgical instrumentconnection portion 502 may include tapered portions 514 that angledownward towards opening 516, thereby defining the channel into opening516. Accordingly, tapered portions 514 ensure that the shaft of thesurgical instrument is properly inserted into opening 516 in one of twoorientations by rotating coupler body 500 and accordingly distal wristlink 316 to align with the longitudinal axis of the surgical instrumentin one of two orientations. For example, tapered portions 514 mayfacilitate in “self-alignment” of the distal end of robot arm 300, e.g.,by causing coupler interface 400 which is coupled to coupler body 500 toautomatically rotate relative to distal wrist link 316 about axis Q7 atpassive joint 328 as the instrument shaft is guided down taperedportions 514, such that the longitudinal axis of opening 516 aligns withthe longitudinal axis of the surgical instrument. Accordingly, the userdoes not need to align the instrument shaft to opening 516, but rather,opening 516 rotates via rotation of coupler body 500 and surgicalinstrument coupler interface 400 relative to distal wrist link 316 toalign with the longitudinal axis of the instrument shaft.

In addition, surgical instrument connection portion 502 may includeclamp 518 pivotally coupled to surgical instrument connection portion502 about axis 512, such that clamp 518 may be transitionable between anunlocked state and a locked state. Moreover, clamp 518 may be pivotallycoupled to surgical instrument connection portion 502 via a torsionspring, such that clamp 518 is biased toward the locked state. Clamp 518may include locking portion 520 configured to secure the surgicalinstrument within opening 516 when clamp 518 is in its locked state. Forexample, a lower surface of locking portion 520 may define the uppersurface of opening 516 when clamp 518 is in its locked state, such thatlocking portion 520 prevents upward movement of the surgical instrumentwhen the surgical instrument is positioned within opening 516 and clamp518 is in its locked state.

The upper surface of locking portion 520 may be tapered to facilitateguidance of the surgical instrument into opening 516 along with taperedportions 514. Accordingly, the tapered angle of locking portion 520 maybe alone sufficient to permit a surgical instrument to be inserted intoopening 516, such that insertion of the surgical instrument towardsopening 516 applies a force against the tapered upper surface of lockingportion 520, thereby causing clamp 518 to rotate about axis 512 from thelocked state to the unlocked state to permit the surgical instrument tobe received by opening 516. Clamp 518 further may include handle 522sized and shaped to be actuated by the user's fingers to transitionclamp 518 from the locked state to the unlocked state. For example,handle 522 may be actuated to transition clamp 518 to the unlocked statefor insertion of the surgical instrument into opening 516, and/or forremoval of the surgical instrument from opening 516.

Moreover, coupler body 500 further may include switch 524 pivotallycoupled to surgical instrument connection portion 502, and configured tofacilitate securement of the surgical instrument within opening 516. Forexample, switch 524 may include one or more surgical instrumentengagement portions 526, each having a geometry that corresponds withthe outer diameter of the shaft of the surgical instrument to beinserted within opening 516. In addition, switch 524 may include handleportion 528 sized and shaped to be actuated by the user's fingers totransition switch 524 between an unlocked state and a locked state wheresurgical instrument engagement portion 526 engages with the surgicalinstrument shaft within opening 516 and applies a friction force to thesurgical instrument shaft.

Moreover, in its locked state, surgical instrument engagement portion526 further defines opening 516. Surgical instrument engagement portion526 may have a coefficient of friction, such that when the surgicalinstrument is disposed within opening 516 and switch 524 is in itslocked state, surgical instrument engagement portion 526 applies afriction force against the surgical instrument that preventslongitudinal movement of the surgical instrument relative to couplerbody 500, while permitting rotational movement of the surgicalinstrument within opening 516. For example, the friction force appliedto shaft 10 a by surgical instrument engagement portion 526 facilitatessecurement of shaft 10 a within coupler body 500, such that longitudinalmovement of surgical instrument 10 is prevented unless the longitudinalforce applied to surgical instrument 10 exceeds at least the frictionforce applied to shaft 10 a by surgical instrument engagement portion526, while the rotational force required to overcome the friction forceand cause rotational of shaft 10 a within opening 516 is minimized.Accordingly, when the surgical instrument is disposed within opening516, switch 524 may be actuated to its unlocked state to permit the userto readjust/move the surgical instrument longitudinally relative tocoupler body 500 within opening 516, and back to its locked state toprevent longitudinal movement of the surgical instrument relative tocoupler body 500. Preferably, both switch 524 and clamp 518 must be intheir unlocked states to permit removal of the surgical instrument fromcoupler body 500.

Alternatively, the coupler interface and the coupler body may beconstructed as described in U.S. Patent Appl. Pub. No. 2023/0114137, asshown in FIGS. 7D to 7H. For example, coupler interface 600 may becoupled to or otherwise integrated with link 316, and connection portion650 may be coupled to a coupler body, e.g., coupler body 500 or couplerbody 900, for removably coupling the coupler body to coupler interface600. As shown in FIG. 7D, coupler interface 600 may include protrusion604 extending from flat portion 602. Flat portion 602 may have an outerdiameter that coincides with the outer diameter of link 316. Inaddition, coupler interface 600 may include extended portion 608extending from flat portion 602 and configured to be inserted withinlink 316. Like protrusion 404, protrusion 604 may have a non-circularprofile, which corresponds to the geometry of groove 652 of connectionportion 650 of the coupler body, as described in further detail below.For example, as shown in FIG. 7D, protrusion 604 may have adiamond-shaped profile. Accordingly, when protrusion 604 is disposedwithin groove 652 of connection portion 650, rotational movement betweencoupler interface 600 and connection portion 650 is prevented.

Moreover, protrusion 604 may include one or more locking portions 606disposed on the outer surface of the sidewall of protrusion 604. Forexample, locking portions 606 may be indentations/grooves extendingalong the outer surface of protrusion 604, and sized and shaped toengage with locking arms 660 of connection portion 650, as described infurther detail below, for securing the coupler body to coupler interface600, and for securing the sterile drape between connection portion 650and coupler interface 600. Preferably, protrusion 604 includes a pair oflocking portions 606. For example, as shown in FIGS. 7D and 7F, the pairof locking portions 606 may be disposed on opposing apexes of thediamond-shaped profile of protrusion 604. Accordingly, connectionportion 650 may be securely coupled to coupler interface 600 in twoorientations.

As shown in FIG. 7D, coupler interface 600 may include one or moreadditional protrusions 610, e.g., “mating dots,” disposed on flatportion 602. For example, coupler interface 600 may include a pluralityof protrusions 610, preferably evenly spaced apart along flat portion602, e.g., adjacent to the outer edge of flat portion 602. Protrusions610 may have a geometry that corresponds with the geometry of one ormore additional grooves 654 of connection portion 650, as shown in FIG.7E. For example, protrusions 610 may have a semi-spherical shape, andgrooves 654 may have a corresponding semi-spherical shape. As shown inFIG. 7E, grooves 654 may be disposed along connection portion 650, suchthat grooves 654 are aligned with protrusions 610 so that protrusions610 may be disposed within grooves 654 when connection portion 650 iscoupled to coupler interface 600, as shown in FIG. 7F. Accordingly, whenprotrusion 602 is disposed within groove 652 of connection portion 650,and protrusions 610 are disposed within grooves 654, rotational movementbetween coupler interface 600 and connection portion 650 is prevented.As will be understood by a person having ordinary skill in the art,coupler interface 600 and connection portion 650 may include more orless protrusions 610 and grooves 654, respectively, that are shown inFIGS. 7D and 7E. In addition, other coupler interfaces and couplerbodies described herein, e.g., coupler interface 400 and coupler body500, 900, may include similar additional protrusions and grooves forproviding additional stabilization when the coupler interface is coupledto the coupler body.

As shown in FIG. 7G, connection portion 650 may include a pair oflocking arms 660, which may be constructed similar to locking arms 506of connection portion 504, for releasably securing connection portion650 to coupler interface 600. For example, locking arms 660 may includehandle portion 664 sized and shaped to be actuated by the user'sfingers, and connection portion 662 sized and shaped to engage withlocking portions 606 of protrusion 604. Accordingly, locking arms 660may transition between an unlocked state where locking arms 660 aredisengaged from protrusion 604, as shown in FIG. 7G, and a locked statewhere connection portion 662 of locking arms 660 are engaged withlocking portions 606 of protrusion 604, as shown in FIG. 7H, such thatlocking arms 660 are biased toward the locked state.

FIG. 8A is a cross-sectional view of coupler body 500 when coupler body500 is not coupled to coupler interface 400, FIG. 8B is across-sectional view of coupler body 500 when coupler body 500 iscoupled to coupler interface 400, and FIG. 8C is a cross-sectional viewof coupler body 500 when coupler body 500 is coupled to couplerinterface 400, and a surgical instrument is coupled to coupler body 500.As shown in FIG. 8A, coupler body 500 further may include holder 530disposed within surgical instrument connection portion 502. Holder 530is configured to be slidably disposed within surgical instrumentconnection portion 502, e.g., toward or away from coupler interfaceconnection portion 504. Moreover, holder 530 is configured to holdmagnet 540. For example, holder 530 may include one or more cradles 534extending between a contact surface, e.g., friction pad 532, and magnetharness 538 configured to hold magnet 540. Each cradle 534 of holder 530may include channel 536 extending within cradle 534 in a direction frommagnet harness 538 towards friction pad 532. Channels 536 may be sizedand shaped to slidably receive a longitudinally extending rodtherethrough, such that the longitudinally extending rod extends alongaxis 512 between channels 536. Clamp 518 may be pivotally coupled to thelongitudinally extending rod, such that clamp 518 may rotate about axis512, as described above. Axis 512 may be fixed relative to surgicalinstrument connection portion 502, such that holder 530 may movetoward/away from coupler interface connection portion 504 via movementof channel 536 along the longitudinally extending rod.

As shown in FIG. 8A, the upper surface of friction pad 532 defines thelower surface of opening 516. The upper surface of friction pad 532 mayhave a curved profile, which may coincide with the curvature of thesurgical instrument. Friction pad 532 may have a coefficient offriction, such that when the surgical instrument is disposed withinopening 516 and switch 524 is in its locked state, friction pad 532applies a friction force against the surgical instrument that preventslongitudinal movement of the surgical instrument relative to couplerbody 500, while permitting rotational movement of the surgicalinstrument within opening 516. As will be understood by a person havingordinary skill in the art, friction pad 532 may be formed of a single ormultiple pieces configured to contact the surgical instrument withinopening 516, or alternatively, may be wrapped around the upper surfaceof holder 530 or otherwise integrated with holder 530. When switch 524is moved to its unlocked state, the friction force of friction pad 532may not be sufficient to prevent longitudinal movement of the surgicalinstrument relative to coupler body 500.

Magnet 540 may have a magnetic force such that when coupler body 500 iscoupled to coupler interface 400, magnet 540 induces a magnetic field,which may be detected by one or more magnetic field sensors, e.g.,disposed within link 316 and/or coupler interface 400. Accordingly, thestrength of the induced magnetic field will be proportional to thedistance between magnet 540 and coupler interface 400 such that themagnetic field detected by the magnetic field sensors may be indicativeof the position of magnet 540, and accordingly holder 530, withincoupler body 500. Similarly, when no magnetic field is induced viamagnet 540, the magnetic field sensors may detect that coupler body 500is not coupled to coupler interface 400. Moreover, the repulsion magnetof coupler interface 400 may have a magnetic force such that whencoupler body 500 is coupled to coupler interface 400, the repulsionmagnet applies a magnetic force to magnet 540 to thereby cause magnet540, and accordingly holder 530, to move away from coupler interfaceconnection portion 504. The position of holder 530 relative to couplerbody 500 may be indicative of whether a surgical instrument is or is notcoupled to coupler body 500 when coupler body 500 is coupled to couplerinterface 400. For example, as shown in FIG. 8A, without the repulsionmagnet of coupler interface 400 within the vicinity of magnet 540, nomagnetic force will be applied to magnet 540 to cause displacement ofholder 530, e.g., toward opening 516. Accordingly, holder 530 may be ina neutral position, e.g., towards coupler interface connection portion504 due to gravity.

As shown in FIG. 8B, when coupler body 500 is coupled to couplerinterface 400 and no surgical instrument is coupled to coupler body 500,the repulsion magnet may apply a magnetic force to magnet 540, therebycausing magnet 540, and accordingly holder 530, to move towards opening516 and away from coupler interface 400 within channel 503, e.g., to aposition within coupler body 500 with a maximum distance from couplerinterface 400. Thus, when coupler body 500 is coupled to couplerinterface 400, friction pad 532 may be closer to locking portion 520 ofclamp 518, thereby reducing the size of opening 516. Moreover, theinduced magnetic field by magnet 540 when magnet 540 is in the positionwithin channel 503 farthest away from coupler interface 400 responsiveto the magnetic force of the repulsion magnet when coupler body 500 iscoupled to coupler interface 400 and no instrument is coupled to couplerbody 500, may provide a clean signal that may be detected by themagnetic field sensors, indicative of coupler body 500 being coupled tocoupler interface 400 without a surgical instrument attached thereto.Accordingly, the system may determine that coupler body 500 is coupledto coupler interface 400 with no surgical instrument coupled to couplerbody 500, based on the strength of the magnetic field induced by magnet540, e.g., when magnet 540 is a maximum distance from coupler interface400 within coupler body 500.

As shown in FIG. 8C, when shaft 10 a of surgical instrument 10 isinserted within opening 516, shaft 10 a applies a downward force againstfriction pad 532, thereby causing holder 530 to move downward withinchannel 503 and increasing the size of opening 516 until shaft 10 a iscompletely disposed within opening 516 and clamp 518 is permitted totransition back to its locked state, such that the shaft 10 a ispositioned between the lower surface of locking portion 520 and frictionpad 532. Upon release of surgical instrument 10 by the user, frictionpad 532 applies an upward force against shaft 10 a due to the magneticforce of the repulsion magnet applied against magnet 540, such thatshaft 10 a is pinned between the lower surface of locking portion 520and friction pad 532. Accordingly, the magnetic field induced by magnet540 when magnet 540 is in the position within channel 503 responsive tothe magnetic force of the repulsion magnet when coupler body 500 iscoupled to coupler interface 400 as well as the force applied to holder530, and accordingly magnet 540, by shaft 10 a via friction pad 532, maybe detected by the magnetic field sensors, and which may be indicativeof coupler body 500 being coupled to coupler interface 400, and surgicalinstrument 10 being coupled to coupler body 500. Accordingly, the systemmay determine that coupler body 500 is coupled to coupler interface 400and that surgical instrument 10 is coupled to coupler body 500, based onthe strength of the magnetic field induced by magnet 540.

Moreover, the position of magnet 540 within channel 503 will depend onthe diameter size of the surgical instrument disposed within opening 516when coupler body 500 is coupled to coupler interface 400, such that theinduced magnetic field will vary based on the surgical instrument shaftsize disposed within opening 516. Accordingly, the system may identifythe precise size of the surgical instrument shaft based on the strengthof the magnetic field induced by magnet 540, as detected by the magneticfield sensors. Based on the identified type of surgical instrumentcoupled to coupler body 500, the system may load the calibration fileassociated with the identified surgical instrument as described above.Moreover, based on the identified make of the surgical instrument,provided that each specific make has a distinguishable shaft diametersize, the system may determine whether the attached surgical instrumentis authorized for use with the system.

Referring now to FIG. 9 , another coupler body configured to beremovably coupled to a surgical instrument having a predefined shaftdiameter is provided. Coupler body 900 may be constructed similar tocoupler body 500. For example, surgical instrument connection portion902, channel 903, coupler interface connection portion 904, groove 905,locking arms 906, axis 912, tapered portions 914, opening 916, clamp918, switch 924, and holder 930 of coupler body 900 correspond withsurgical instrument connection portion 502, channel 503, couplerinterface connection portion 504, groove 505, locking arms 506, axis512, tapered portions 514, opening 516, clamp 518, switch 524, andholder 530 of coupler body 500, respectively. Coupler body 900 differsfrom coupler body 500 in that coupler body 900 may be configured to beremovably coupled to a smaller diameter surgical instrument, e.g., a 5mm surgical instrument such as surgical instrument 12 described above.Coupler body 500 and coupler body 900 may include visual indicators,e.g., color and/or size markings, to readily inform a user of therespective coupler body size.

Referring now to FIGS. 10A to 10D, robot arms 300 may be positioned in asurgical drape-ready configuration. As shown in FIG. 10A, robot arm 300may be extended such that wrist portion 311, elbow link 310, andshoulder link 305 extend away from shoulder portion 304 of the base topermit a surgical/sterile drape to be draped over each component ofrobot arm 300 (as shown in FIG. 10C). Moreover, as shown in FIG. 10B,when there are two robot arms, e.g., robot arm 300 a and robot arm 300b, robot arm 300 a and robot arm 300 b may be angled away from eachother, e.g., by rotating shoulder portion 304 a relative to base portion302 a of robot arm 300 a and/or by rotating shoulder portion 304 brelative to base portion 302 b of robot arm 300 b, such that wristportion 311 a, elbow link 310 a, and shoulder link 305 a extend awayfrom wrist portion 311 b, elbow link 310 b, and shoulder link 305 b.This configuration permits efficient and accessible draping of therespective robot arms with a surgical/sterile drape (as shown in FIG.10D). Moreover, in the extended position, the robot arms may be withinthe virtual haptic boundary, such that the robot arms are in the hapticmode and a high level of impedance is applied to the robot arms therebymaking movement of the robot arms more viscous, which makes it easierfor the operator to drape the robot arms, yet provide movement theretoif necessary. As described in further detail below, system 100 may storethe predetermined drape-ready configuration, such that upon actuation ofthe system in a “drape mode” during setup, system 100 may cause robotarms 300 to automatically move to the predetermined drape-readyconfiguration. In addition, if the robot arms are not within thepredefined virtual haptic boundary around the workspace in thedrape-ready configuration, the system may apply a temporary localizedvirtual haptic boundary at least the distal end of the robot arms, asdescribed in further detail below.

FIG. 10C illustrates a single robot arm 300 draped with sterile drape800. As shown in FIG. 10C, one or more bands/straps, e.g., bands 802,may be used to secure sterile drape 800 to robot arm 300. For example,as shown in FIG. 10C, a first band 802 may be secured to sterile drape800 on the elbow link of robot arm 300, and a second band 802 may besecured to sterile drape 800 on the shoulder link of robot arm 300.Bands 802 may be made of an elastic material such that they may beeasily stretched and passed over robot arm 300 until positioned at thetarget location. As will be understood by a person having ordinary skillin the art, less or more than two bands may be used to secure steriledrape 800 over each of the robot arms.

Preferably, a single sterile drape 800 having first drape portion 801 asized and shaped for draping robot arm 300 a and second drape portion801 b sized and shaped for draping robot arm 300 b, as shown in FIG.10E, may be used to drape both robot arms 300 a, 300 b and at least thefront side of platform 200, as shown in FIG. 10D. As shown in FIG. 10E,sterile drape 800 may be completely closed at the end portions thereof,e.g., the distal portion of first and second drape portions 801 a, 801 bin contact with the respective coupler interface of the robot arm.Moreover, sterile drape 800 may include one or more rigid guides 804,e.g., guides 804 a, 804 b, integrated with sterile drape 800, which maybe grabbed by the user to guide sterile drape 800 over each robot arm.For example, guides 804 may be formed of cardboard, plastic, metal, oranother rigid material. As shown in FIG. 10F, guides 804 a, 804 b may bepassed over robot arms 300 a, 300 b, respectively, such that guides 804a, 804 b may rest on the respective base portions of robot arms 300 a,300 b, when sterile drape 800 is completely draped over the robot arms.As will be understood by a person having ordinary skill in the art,sterile drape 800 may include more than two guides and/or the two ormore guides may be disposed on other locations of sterile drape 800 thanas shown in FIG. 10E.

As described above, sterile drape 800 may include one or more bands,e.g., bands 802 a, 80 b, configured to secure drape portions 801 a, 801b to robot arms 300 a, 300 b, respectively, as shown in FIG. 10E. Forexample, bands 802 a, 802 b may be made of an elastic material such thatthey may be easily stretched and passed over robot arms 300 a, 300 buntil positioned at the target location. In some embodiments, bands 802a, 802 b may be integrated with sterile drape 800, and affixed tothemselves when positioned at the target locations with respect to robotarms 300 a, 300 b. As shown in FIG. 10E, a proximal edge of steriledrape 800 may include elastic band 806 to facilitate engagement withdrape hook 209 of light house 203. As shown in FIG. 10G, drape hook 209may protrude outwardly from a surface of lighthouse 203, and further mayinclude grooved portion to thereby form a hook shape for easilyreceiving the proximal edge of sterile drape 800. Accordingly, elasticband 806 may be hooked onto drape hook 209 of lighthouse 203 of platform200, e.g., below markers 205 on the front side of lighthouse 203, asshown in FIG. 10G. In addition, sterile drape 800 further may be markedand/or secured with one or more peel-off labels, e.g., labels 808 a, 808b, having directional markings to facilitate efficient application ofthe drape over the robot arms.

Alternatively, in some embodiments, sterile drape 800 may have anopening (that can optionally have a sterile seal or interface) in adistal portion thereof that a portion of robot arm 300, couplerinterface 400, coupler body 500, and/or the surgical instrument may passthrough. Drapes having a sealed end portion without any openings, andbeing sealed along a length thereof may provide a better sterile barrierfor system 100. Accordingly, all of robot arm 300 may be located insidesterile drape 800 and/or be fully enclosed within sterile drape 800,except at an opening at a proximal end of sterile drape 800, e.g., nearthe base of robot arm 300. In some embodiments, coupler body 500 andcoupler interface 400 may have electrical connectors to produce anelectronic connection between robot arm 300 and the surgical instrument.Accordingly, the electrical signals may be transmitted through steriledrape 800. The surgical instrument and the coupler body may instead bepassive or non-electronic such that no electrical wires need passthrough sterile drape 800.

Referring now to FIGS. 11A to 11D, rotation of distal shoulder link 308relative to proximal shoulder link 306 of shoulder link 305 is provided.As described above, motorized axis Q3 may be a “setup” axis, such thatdistal shoulder link 308 may be automatically rotated relative toproximal shoulder link 306 upon actuation of actuator 330, e.g., duringa setup stage of robot arm 300, prior to operation of robot arm 300 in asurgical procedure. As shown in FIG. 11A, shoulder portion 304optionally may be initially rotated relative to base portion 302 to adesired position, thereby causing rotation of all the link distal toproximal shoulder link 306, which is coupled to shoulder portion 304, torotate relative to base portion 302 and provide ample space for rotationof robot arm 300 about joint 320. Moreover, as shown in FIG. 11A, wristportion 311 may be at least partially extended away from base portion302 so as to not collide with any components of robot arm 300 uponrotation of robot arm 300 about joint 320.

As described above, M4 must be actuated, e.g., via actuator 330, toautomatically rotate distal shoulder link 308 relative to proximalshoulder link 306 at joint 320. As shown in FIG. 11B, motor M4 may beoperatively coupled to a motion transmission mechanism coupled to distalshoulder link 308, e.g., worm gear 323, via gear 321, such thatactuation of motor M4 causes rotation of distal shoulder link 308relative to proximal shoulder link 306 via engagement between gear 321and worm gear 323. FIG. 11C illustrates robot arm 300 in a desirablelocation for a specific laparoscopic procedure upon rotation of distalshoulder link 308 relative to proximal shoulder link 306. FIG. 11Dillustrates robot arm 300 a in the desirable location upon rotation ofdistal shoulder link 308 a relative to proximal shoulder link 306 a,relative to robot arm 300 b.

As described in further detail below, system 100 may store apredetermined robot arm configuration including a predetermined degreeof rotation of distal shoulder link 308 relative to proximal shoulderlink 306 for one or more known surgical procedures, such that uponactuation of the system to an “operation-ready mode” during setup,system 100 may cause robot arms 300 to automatically move to thepredetermined robot arm configuration. Moreover, as the robot arm ismoved, either manually by the user or automatically during setup, basedon depth data obtained from the one or more optical scanners, the systemmay detect when either the stages of platform 200 or the robot armapproaches a predetermined distance threshold relative to an object inthe operating room, e.g., the surgical bed. Accordingly, the system mayautomatically reconfigure the robot arm to avoid a collision with theobject, e.g., by automatically actuating motorized joint 320 to rotatedistal shoulder link 308 relative to proximal shoulder link 306.Similarly, system 100 may automatically reconfigure the robot arm toavoid a collision with an object in the operating room by automaticallyactuating motorized joint 320 during a surgical procedure.

FIGS. 12A and 12B illustrate exemplary data produced by optical scanner202. For example, FIG. 12A illustrates image data captured by opticalscanner 202, and FIG. 12B illustrates a depth map of at least someobjects within the surgical space generated from the data captured byoptical scanner 202. Specifically, optical scanner 202 may create adepth map, e.g., point clouds, where each pixel's value is related tothe distance from optical scanner 202. For example, the differencebetween pixels for a first object (such as a first surgical instrument)and a second object (for example, a trocar) will enable the system tocalculate the distance between the surgical instrument and the trocar.Moreover, the difference between pixels for a first object (such as afirst surgical instrument) at a first point in time and the first objectat a second point in time will enable the system to calculate whetherthe first object has moved, the trajectory of movement, the speed ofmovement, and/or other parameters associated with the changing positionof the first object.

For example, the system may measure and record any of the followingwithin the coordinate space of the system: motion of the handheldsurgical instruments manipulated by the surgeon (attached to or apartfrom a robot arm); the presence/absence of other surgical staff (e.g.,scrub nurse, circulating nurse, anesthesiologist, etc.); the height andangular orientation of the surgical table; patient position and volumeon the surgical table; presence/absence of the drape on the patient;presence/absence of trocar ports, and if present, their position andorientation; gestures made by the surgical staff; tasks being performedby the surgical staff; interaction of the surgical staff with thesystem; surgical instrument identification; attachment or detachment“action” of surgical instruments to the system; position and orientationtracking of specific features of the surgical instruments relative tothe system (e.g., camera head, coupler, fiducial marker(s), etc.);measurement of motion profiles or specific features in the scene thatallow for the phase of the surgery to be identified; position,orientation, identity, and/or movement of any other instruments,features, and/or components of the system or being used by the surgicalteam.

The system may combine measurements and/or other data described abovewith any other telemetry data from the system and/or video data from thelaparoscope to provide a comprehensive dataset with which to improve theoverall usability, functionality, and safety of the co-manipulationrobot-assisted surgical systems described herein. For example, as thesystem is being setup to start a procedure, optical scanner 202 maydetect the height and orientation of the surgical table. Thisinformation may allow the system to automatically configure the degreesof freedom of platform 200 supporting robot arms 300 to the desired orcorrect positions relative to the surgical table. Specifically, opticalscanner 202 may be used to ensure that the height of platform 200 isoptimally positioned to ensure that robot arms 300 overlap with theintended surgical workspace. In addition, as described above, the systemmay automatically reconfigure the degrees of freedom of platform 200 aswell as the arrangement of robot arms 300 responsive to movement of thesurgical table, and accordingly the trocar(s), to maintain relativeposition between the distal end of the robot arms and the trocar(s).

In addition, optical scanner 202 may identify the specific surgeoncarrying out the procedure, such that the system may use the surgeon'sidentity to load a system profile associated with the particular surgeoninto the system. The system profile may include information related to asurgeon's operating parameter and/or preferences, a surgeon's patientlist having parameters for each patient, the desired or requiredalgorithm sensitivity for the surgeon, the degree of freedom positioningof the support platform, etc. Examples of algorithm sensitivities thatmay be surgeon-specific include: adapting/adjusting the force requiredto transition from passive mode to co-manipulation mode (e.g., from lowforce to high force), adapting/adjusting the viscosity felt by thesurgeon when co-manipulating the robot arm (e.g., from low viscosity tohigh viscosity), preferred surgical instrument trajectories whenperforming specific laparoscopic procedures, etc. Moreover, thesurgeon's preferences may include preferred arrangements of robot arm300, e.g., the positioning of the links and joints of robot arm 300relative to the patient, with regard to specific surgical instruments,e.g., the preferred arrangement may be different between a laparoscopeand a retractor.

Based on the data captured by optical scanner 202, the system maygenerate a virtual model of the pieces of capital equipment and/or otherobjects in an operating room that are within a range of movement of therobot arms in the same co-ordinate space as the robot arms and surgicalinstruments coupled thereto, such that the virtual model may be storedand monitor, e.g., to detect potential collisions. Additionally, thesystem may track the position and orientation of each virtual model, andthe objects within the virtual models as the objects move relative toeach other, such that the system may alert the user if the proximity of(i.e., spacing between) any of the virtual models or objects falls belowa predefined threshold, e.g., within 50 mm, 75 mm, from 30 mm or less to100 mm, or more. The system may use this information to recommend arepositioning of platform 200 and/or other components of the system, thesurgical table, and/or patient, and/or prevent the robot arm fromswitching to the co-manipulation mode as a result of the force appliedto the robot arm by the collision with the staff member, even if theforce exceeds the predetermined force threshold of the robot arm.Moreover, the system may stop or inhibit (e.g., prevent) furthermovement of a robot arm, e.g., freeze the robot arm, if the proximity ofany of the virtual models or objects, e.g., a robot arm reaches or fallsbelow the predefined threshold relative to another objects within thesurgical space.

Moreover, based on the data captured by optical scanner 202, the systemmay track the motion of the handheld surgical instruments that aredirectly and independently controlled by the surgeon, that are notcoupled with the robot arm. For example, the optical scanner 202 maytrack a clearly defined feature of the instrument, a fiducial markerattached to the instrument or to the gloves (e.g., the sterile gloves)of the surgeon, the coupler between the robot arm and the instrument, adistal tip of the instrument, and/or any other defined location on theinstrument. The following are examples of uses and purposes of themotion data: (i) closing a control loop between a handheld instrumentand the robot arm holding the camera, thus allowing the surgeon to servo(i.e., move) the camera by “pointing” with a handheld instrument; (ii)tracking information that may be used independently or in combinationwith other data streams to identify the phase of the surgical procedure;(iii) to identify the dominant hand of the surgeon; (iv) to monitormetrics associated with the experience of the surgeon; (v) to identifywhich tools the surgeon is using and when to change them for othertools; and/or (vi) tracking of the skin surface of the patient, as wellas the number, position and orientation of the trocar ports. This dataand information also may be used and computed by the system as part ofthe co-manipulation control paradigm. As will be understood by a personhaving ordinary skill in the art, the location/movement of a surgicalinstrument coupled to a robot arm of the system will be known by thesystem based on the known robot telemetry and current kinematics of therobot arm, without the need of data captured by optical scanner 202.

Based on the data captured by optical scanner 202, the system furthermay track the which instrument is being used in a respective port, howoften instruments are swapped between ports, which ports have manuallyheld instruments versus instruments coupled to the robot arm, to monitorand determine if additional trocar ports are added, if the system isholding the instruments in place while the patient or surgical table ismoving (in which case, the system may change the operational mode of therobot arms to a passive mode and accommodate the movement byrepositioning robot arm 300 and/or platform 200), and/or otherconditions or parameters of the operating room or the system. Theknowledge of the position and orientation of the skin surface and trocarports relative to the robot arms may facilitate the implementation of“virtual boundaries” as described in further detail below.

Referring now to FIGS. 13A to 13D, setup of the co-manipulation surgicalsystem is provided. As shown in FIG. 13A, platform 200 may be moved to adesirable position relative to patient table PT by a user, e.g., viawheels 204, while robot arms 300 a, 300 b are in their respective stowedconfigurations. As platform 200 is being moved toward the patient, thescene may be directly observed by one or more optical scanners 202 andone or more proximity sensors 212. From the depth maps observed andgenerated by optical scanners 202 and the proximity data observed andgenerated by proximity sensors 212, key features may be identified suchas, for example, the height and/or location of patient table PT, thesurface of the patient's abdomen, the position and other characteristicsof the surgeon, including the surgeon's height, the trocar port(s), andthe base of robot arms 300 a, 300 b, e.g., base portions 302 a, 302 band shoulder portions 304 a, 304 b, robot arms 300 a, 300 b, and/or oneor more surgical instruments coupled with the robot arms, and thedistance between platform 200 and robot arms 300 a, 300 b and otherobjects in the room such as the patient table PT. Identification of suchkey features may be carried out using standard computer visiontechniques such as template matching, feature tracking, edge detection,etc.

As each feature is registered, its position and orientation may beassigned a local co-ordinate system and transformed into the globalco-ordinate system the system using standard transformation matrices.Once all features are transformed into a single global co-ordinatesystem, an optimization algorithm, e.g., least squares and gradientdescent, may be used to identify the most appropriate vertical andhorizontal positions of robot arms 300 a, 300 b, which may be adjustedvia platform 200, to maximize the workspace of the robot arms withrespect to the insertion point on the patient. The optimal workspace maybe dependent on the surgical operation to be performed and/or thesurgeon's preferred position. Moreover, the system may generate and adisplay a virtual map, e.g., via GUI 210, graphically depicting theidentified features within the operating room based on the depth andproximity data to guide the user when moving platform 200, as describedin further detail below with regard to FIG. 33 .

Referring again to FIG. 13B, when platform 200 is in its desiredposition relative to patient table PT, such that wheels 204 are locked,robot arms 300 a, 300 b may be extended away from their respectivestowed configurations. As shown in FIG. 13C, the vertical position ofthe robot arms relative to platform 200 may be adjusted to the desiredposition, and as shown in FIG. 13D, the horizontal position of the robotarms relative to platform 200 may be adjusted to the desired position.The desired positions of the robot arms may be stored as an“operation-ready” configuration, which may be specific to the operationbeing performed, as well as the surgeon's preferences. Accordingly, whenplatform 200 is in the desired position relative to patient table PT, asshown in FIG. 13A, system may be actuated, e.g., via GUI 210 or voicecontrol, etc., to automatically move platform 200 and robot arms 300 a,300 b towards the “operation ready” configuration relative to patienttable PT, while avoiding collisions between platform 200 and robot arms300 a, 300 b and other objects in the room based on the depth andproximity data observed and generated by optical sensors 202 andproximity sensors 212.

Referring now to FIG. 14 , components that may be included inco-manipulation robot platform 1400 are described. Platform 1400 mayinclude one or more processors 1402, communication circuitry 1404, powersupply 1406, user interface 1408, and/or memory 1410. One or moreelectrical components and/or circuits may perform some of or all theroles of the various components described herein. Although describedseparately, it is to be appreciated that electrical components need notbe separate structural elements. For example, platform 1400 andcommunication circuitry 1404 may be embodied in a single chip. Inaddition, while platform 1400 is described as having memory 1410, amemory chip(s) may be separately provided.

Platform 1400 may contain memory and/or be coupled, via one or morebuses, to read information from, or write information to, memory. Memory1410 may include processor cache, including a multi-level hierarchicalcache in which different levels have different capacities and accessspeeds. The memory also may include random access memory (RAM), othervolatile storage devices, or non-volatile storage devices. Memory 1410may be RAM, ROM, Flash, other volatile storage devices or non-volatilestorage devices, or other known memory, or some combination thereof, andpreferably includes storage in which data may be selectively saved. Forexample, the storage devices can include, for example, hard drives,optical discs, flash memory, and Zip drives. Programmable instructionsmay be stored on memory 1410 to execute algorithms for, e.g.,calculating desired forces to be applied along robot arm 300 and/or thesurgical instrument coupled thereto and applying impedances atrespective joints of robot arm 300 to effect the desired forces.

Platform 1400 may incorporate processor 1402, which may consist of oneor more processors and may be a general purpose processor, a digitalsignal processor (DSP), an application specific integrated circuit(ASIC), a field programmable gate array (FPGA) or other programmablelogic device, discrete gate or transistor logic, discrete hardwarecomponents, or any suitable combination thereof designed to perform thefunctions described herein. Platform 1400 also may be implemented as acombination of computing devices, e.g., a combination of a DSP and amicroprocessor, a plurality of microprocessors, one or moremicroprocessors in conjunction with a DSP core, or any other suchconfiguration. Platform 1400, in conjunction with firmware/softwarestored in the memory may execute an operating system (e.g., operatingsystem 1446), such as, for example, Windows, Mac OS, QNX, Unix orSolaris 5.10. Platform 1400 also executes software applications storedin the memory. For example, the software may be programs in any suitableprogramming language known to those skilled in the art, including, forexample, C++, PHP, or Java.

Communication circuitry 1404 may include circuitry that allows platform1400 to communicate with an image capture devices such as opticalscanner and/or endoscope. Communication circuitry 1404 may be configuredfor wired and/or wireless communication over a network such as theInternet, a telephone network, a Bluetooth network, and/or a WiFinetwork using techniques known in the art. Communication circuitry 1404may be a communication chip known in the art such as a Bluetooth chipand/or a WiFi chip. Communication circuitry 1404 permits platform 1400to transfer information, such as force measurements on the body wall atthe trocar insertion point locally and/or to a remote location such as aserver.

Power supply 1406 may supply alternating current or direct current.Power supply 1406 may be a port to allow platform 1400 to be pluggedinto a conventional wall socket, e.g., via a cord with an AC to DC powerconverter and/or a USB port, for powering components within platform1400. Power supply 1406 may be operatively coupled to an emergencyswitch, such that upon actuation of the emergency switch, power stopsbeing supplied to the components within platform 1400 including, forexample, the braking mechanism disposed on at least some joints of theplurality of joints of robot arm 300. For example, the brakingmechanisms may require power to disengage, such that without powersupplied to the braking mechanisms, the braking mechanisms engage toprevent movement of robot arm 300 without power. In direct currentembodiments, power supply may include a suitable battery such as areplaceable battery or rechargeable battery and apparatus may includecircuitry for charging the rechargeable battery, and a detachable powercord. For example, the battery may be an uninterruptable power supply(UPS) that may be charged when the system is plugged in, and which isonly operatively coupled to certain computing components of the system,e.g., processor 1402, such that the battery may automatically providepower to the computing components when the system is temporarilyunplugged from the electrical power source, e.g., to move the system toanother side of a patient table during a multi-quadrant procedure. Insome embodiments, the braking mechanism of wheels 204 of platform 200also may be operatively coupled to the battery, such that they may beengaged/disengaged while the system is unplugged and moved around theoperating room.

User interface 1408 may be used to receive inputs from, and/or provideoutputs to, a user. For example, user interface 1408 may include atouchscreen display (e.g., GUI 210), switches, dials, lights, etc.Accordingly, user interface 1408 may display information such asselected surgical instrument identity and force measurements observedduring operation of robot arm 300. Moreover, user interface 1408 mayreceive user input including adjustments to the predetermined amount ofmovement at the handle of the surgical instrument or the predetermineddwell time period to cause the robot arm to automatically switch to thepassive mode, the predetermined threshold of force applied at the handleof the surgical instrument to cause the robot arm to automaticallyswitch to the co-manipulation mode, a position of the predefined hapticbarrier, an identity of the surgical instrument coupled to the distalend of the robot arm, a vertical height of the robot arm, a horizontalposition of the robot arm, etc., such that platform 1400 may adjust theinformation/parameters accordingly. In some embodiments, user interface1408 is not present on platform 1400, but is instead provided on aremote, external computing device communicatively connected to platform1400 via communication circuitry 1404.

Memory 1410, which is one example of a non-transitory computer-readablemedium, may be used to store operating system (OS) 1446, surgicalinstrument identification module 1412, surgical instrument calibrationmodule 1414, encoder interface module 1416, robot arm positiondetermination module 1418, trocar position detection module 1420, forcedetection module 1422, impedance calculation module 1424, motorinterface module 1426, optical scanner interface module 1428, gesturedetection module 1430, passive mode determination module 1432,co-manipulation mode determination module 1434, haptic modedetermination module 1436, robotic assist mode determination module1438, trajectory generation module 1440, fault detection module 1442,and indicator interface module 1444. The modules are provided in theform of computer-executable instructions/algorithms that may be executedby processor 1402 for performing various operations in accordance withthe disclosure.

For example, during a procedure, the system may continuously run thealgorithms described herein based on the data collected by the system.That data may be collected and/or recorded using any of the componentsand methods disclosed herein, including, e.g., from sensors/encoderswithin the robots, from optical scanning devices in communication withthe other components of the robotic system, and/or from manual inputs byan operator of the system. Accordingly, the algorithms, the data, andthe configuration of the system may enable the user to co-manipulate therobot arms with minimal impact and influence from the weight of therobot arms and/or surgical instruments coupled thereto, force ofgravity, and other forces that traditional robot arms fail to compensatefor. Some of the parameters of the algorithms described herein maycontrol an aspect of the behavior of the system including, e.g.,robustness of detected features, sensitivity to false positives, robotcontrol gains, number of features to track, dead zone radius, etc.

Surgical instrument identification module 1412 may be executed byprocessor 1402 for identifying the surgical instrument coupled to eachof the robot arms, and loading the appropriate calibration file into thecontroller system. For example, the calibration file for each surgicalinstrument may be stored in a database accessible by surgical instrumentidentification module 1412, and may include information associated withthe surgical instrument such as, e.g., instrument type, make, weight,center of mass, length, instrument shaft diameter, etc. Accordingly,when the appropriate calibration file is loaded, and the associatedsurgical instrument is coupled to robot arm 300, the system willautomatically account for the mass of the surgical instrument, e.g.,compensate for gravity on the surgical instrument, when the surgicalinstrument is attached to robot arm 300 based on the data in thecalibration file, such that robot arm 300 may hold the surgicalinstrument in position after the surgical instrument is coupled to therobot arm and the operator lets go of the surgical instrument. Forexample, surgical instrument identification module 1412 may identify thesurgical instrument based on user input via user interface 1408, e.g.,the operator may select the surgical instrument from a database ofsurgical instruments stored in memory 1410.

Moreover, in some embodiments, the system may be configured such thatonly pre-approved, verified surgical instruments, e.g., of a certainmake, are authorized to be used with the system. A list of authorizedinstruments may be stored within a database in memory 1410 and/oruploaded from a remote database, e.g., a cloud database. Surgicalinstrument identification module 1412 may determine that a surgicalinstrument is authorized for use with the system via, e.g., user inputby the user via user interface 1408 indicating that the surgicalinstrument is among a list of pre-approved instruments, the calibrationfile loaded for the surgical instrument either automatically when thesurgical instrument is attached to the robot arm or manually loaded by auser, and/or real-time surgical instrument identification by the system.For example, surgical instrument identification module 1412 may identifythe make of the surgical instrument based on image data observed andgenerated via optical scanners 202 and/or a laparoscope, before orduring a procedure. Specifically, surgical instrument identificationmodule 1412 may identify distinctive features of the surgicalinstrument, e.g., manufacture logo, handle design, instrument packaging,etc., from the image data to determine the type/make of the instrument.For example, many surgical instruments include an identification marker,e.g., brand logo, etched into or otherwise labeled at or near the distaltip of the instrument, and thus, the make of a surgical instrument maybe identified via the video feed of a laparoscope received by opticalscanner interface module 1428 having the distal tip of the surgicalinstrument within the field of view of the laparoscope. Additionally oralternatively, the image data obtain by optical scanner 202 may includemeasurement data associated with the specific instrument, such thatsurgical instrument identification module 1412 may compare such datawith information contained within the database to identify theinstrument and load the appropriate calibration file into the controllersystem.

Moreover, provided that each specific make of a laparoscope may havedistinguishable output video feed quality, e.g., ×−y pixel count, framerate, noise signature, codec, etc., surgical instrument identificationmodule 1412 may identify the make of the instrument by comparing themetadata acquired via the output video feed quality with those expectedfrom an authorized laparoscope. Further, provided that each specificmake of a surgical instrument may have a distinguishable and precisemass, surgical instrument identification module 1412 may identify themake of the instrument based on the mass of the surgical instrument,e.g., during surgical instrument calibration as described in furtherdetail below. Additionally, provided that each specific make of asurgical instrument may have a distinguishable and precise shaftdiameter, surgical instrument identification module 1412 may identifythe surgical instrument based on the specific magnetic field strengthmeasured by sensor 414 induced by the displaced magnet within thecoupler body due to the diameter of the surgical instrument when thesurgical instrument is coupled to the coupler body and the coupler bodyis coupled to coupler interface 400, as described above. Provided thateach specific make of a surgical instrument may have distinguishable andprecise impedance properties, the system may send a vibration pulse downthe surgical instrument when the surgical instrument is coupled to therobot arm, such that surgical instrument identification module 1412 mayidentify the make of the surgical instrument based on the response data.Moreover, surgical instrument identification module 1412 may identifythe make of the surgical instrument based on other measurable propertiessuch as electrical resistance of the surgical instrument and/ormagnetism of the surgical instrument, provided that such properties aredistinguishable for each make of the surgical instrument.

In some embodiments, surgical instrument identification module 1412 mayautomatically identify the surgical instrument coupled with the roboticarm via the coupler body and the coupler interface using, e.g., an RFIDtransmitter chip and reader or receiver (e.g., placing an RFID stickeror transmitter on the surgical instrument that may transmit informationabout the surgical instrument to a receiver of the system), an nearfield communication (“NFC”) device such as a near field magneticinduction communication device, a barcode and scanner or other opticaldevice, a magnet based communication system, reed switches, a Bluetoothtransmitter, the weight of the instrument and/or data gathered from theoptical scanner and a lookup table, an activation code associated withan authorized surgical instrument, and/or any other features ormechanisms described herein or suitable for identification of thesurgical instrument. Surgical instrument identification module 1412further may confirm that a surgical instrument is authorized by checkingfor a license and/or a hospital inventory.

In some embodiments, authorized surgical instruments may includeindicators such as invisible ink on the tool shaft or handle that may beilluminated and detected via optical sensor 202, e.g., infra-redillumination that may be illuminated/detected via an IR-sensitive sensorof optical scanner 202, a unique reflective marking that may beilluminated and detected at a specific wavelength of light, a uniquefeature on the tool and/or coupling mechanism, e.g., shape, profile,indent, latching feature, etc., that facilitates a unique kinematicengagement between the tool and the coupling mechanism, a unique featurebuilt into the sterile drape coupled between the coupler body and thecoupler interface. In some embodiments, the system may be operativelycoupled to a docking station configured to receive the surgicalinstrument therein, and to record measurements and detect identityindicators of the surgical instrument, to thereby update the calibrationfile and determine whether the surgical instrument is authorized.

Accordingly, upon coupling of an unauthorized surgical instrument to therobot arm, the system may generate an audible, visual, and/or hapticalert to inform the user of such unauthorized use, such that correctiveaction may be taken, e.g., replacing the unauthorized tool with anauthorized tool. In some embodiments, the system may apply an increasedlevel of viscosity to the robot arms when an unauthorized tool iscoupled to the robot arm to inform the user via haptic feedback, and/orprevent motion of the system by engaging the braking mechanisms of therobot arm and applying impedance via the motors of the system. Moreover,some advanced features of the system such as instrument centering may bedisabled until an authorized tool is used. In some embodiments, prior tothe start of a procedure, upon attachment of an unauthorized tool, thesystem may lock the robot arm via the braking mechanisms and motorsuntil the unauthorized tool is replaced with an authorized tool.

Moreover, based on the data obtained by optical scanner 202, e.g.,tracked movements of the distal end of a laparoscope coupled to robotarm 300, and/or robot telemetry data obtained by system 100, e.g., knownpositions/movements of robot arm 300 based on the current kinematics ofrobot arm 300 calculated by system 100, in addition to image datacaptured by the laparoscope, the system may identify the type oflaparoscope coupled to robot arm 300. For example, laparoscopes commonlyused during laparoscopic procedures include flat-tipped laparoscopes andangled-tipped laparoscopes, e.g., a laparoscope having a 30 degreeangled tip. The system may determine which laparoscope type is currentlycoupled to robot arm 300 by comparing the image data obtained by opticalscanner 202 of a predefined pattern of movement of the laparoscopeand/or known kinematic data of robot arm 300 during the predefinedpattern of movement of the laparoscope, e.g., moving the distal end ofthe laparoscope in a circular pattern in a plane perpendicular to thelongitudinal axis of the laparoscope, with the image data obtained bythe laparoscope as the laparoscope is being moved in the predefinedpattern of movement. For example, for a flat-tipped laparoscope, theimage data captured by the laparoscope as the distal end of thelaparoscope is moved in a circular pattern in the plane perpendicular tothe longitudinal axis of the laparoscope should move along a circularplanar path, e.g., there will be no change in depth of the field of viewof the laparoscope; whereas, for an angled-tipped laparoscope, the imagedata captured by the laparoscope as the distal end of the laparoscope ismoved in a circular pattern in the plane perpendicular to thelongitudinal axis of the laparoscope will observe a change of depth ofthe field of view of the laparoscope.

Surgical instrument calibration module 1414 may be executed by processor1402 for calibrating a surgical instrument, e.g., a surgical instrumentthat does not currently have an associated calibration file in thedatabase stored in memory 1410. Accordingly, surgical instrumentcalibration module 1414 may calculate measurements and specifications ofa surgical instrument when it is coupled to robot arm 300 and the systemis in calibration mode, as described in further detail below with regardto FIG. 19 , based on force measurements of robot arm 300 applied by thesurgical instrument via force detection module 1422. For example,surgical instrument calibration module 1414 may generate a calibrationfile for the surgical instrument including information such asinstrument type, make, weight, center of mass, length, instrument shaftdiameter, a viscosity parameter of the surgical instrument, etc. Atleast some of the surgical instrument information in the calibrationfile may be provided by user input via user interface 1408, e.g., theinstrument type/make, or may be detected by optical scanner interfacemodule 1428, e.g., the instrument type, the center of mass of theinstrument, the instrument length, and the instrument diameter.

Similarly, memory 1410 may include an additional module, e.g., a systemcalibration module, which may be executed by processor 1402 forcalibrating a new robot arm when a current robot arm is replaced, e.g.,during a surgical procedure, based on the data obtained by opticalscanner 202, with or without utilizing a tracker at the distal end ofthe new robot arm, to ensure the system is accurately aware of thekinematics of the new robot arm. Specifically, the system may calibrateoptical scanner 202 to platform 200, calibrate the new robot arm withrespect to the base portion of the new robot arm, and calibrate the newrobot arm with respect to platform 200 when the new robot arm is coupledto platform 200. For example, based on the telemetry data obtained byoptical scanner 202, the system calibration module may compare theactual real-time movements of the new robot arm as captured by opticalscanner 202 to the movements expected based on commands sent to the newrobot arm by the system, e.g., to execute a preprogrammed routineintended to move the new robot arm in specific positions, and generate adegree of error indicative of a deviation between the actual real-timemovements of the new robot arm and the expected movements of the robotarm based on the preprogrammed routine. Surgical the system calibrationmodule further may execute an optimization algorithm to reduce oreliminate the degree of error between the actual real-time movements andthe expected movements, e.g., until the degree of error falls below apredetermined threshold. This calibration process may occur when thesystem is in a predefined calibration mode, or alternatively, inreal-time during a surgical procedure after the new robot arm is coupledto platform 200.

Encoder interface module 1416 may be executed by processor 1402 forreceiving and processing angulation measurement data from the pluralityof encoders of robot arm 300, e.g., encoders E1-E7, in real time. Forexample, encoder interface module 1416 may calculate the change inangulation over time of the links of robot arm 300 rotatably coupled toa given joint associated with the encoder. As described above, thesystem may include redundant encoders at each joint of robot arm 300, tothereby ensure safe operation of robot arm 300. Moreover, additionalencoders may be disposed on platform 100 to measure angulation/positionof each robot arm relative to platform 200, e.g., the vertical andhorizontal position of the robot arms relative to platform 200.Accordingly, an encoder may be disposed on platform 200 to measuremovement of the robot arms along the vertical axis of platform 200 andanother encoder may be disposed on platform 200 to measure movement ofthe robot arms along the horizontal axis of platform 200.

Robot arm position determination module 1418 may be executed byprocessor 1402 for determining the position of robot arm 300 and thesurgical instrument attached thereto, if any, in 3D space in real timebased on the angulation measurement data generated by encoder interfacemodule 1416. For example, robot arm position determination module 1418may determine the position of various links and joints of robot arm 300as well as positions along the surgical instrument coupled to robot arm300. Based on the position data of robot arm 300 and/or the surgicalinstrument, robot arm position determination module 1418 may calculatethe velocity and/or acceleration of movement of robot arm 300 and thesurgical instrument attached thereto in real time. For example, bydetermining the individual velocities of various joints of robot arm300, e.g., via the encoder associated with each joint of the variousjoints, robot arm position determination module 1418 may determine theresultant velocity of the distal end of robot arm 300, which may be usedby passive mode determination module 1432 to determine whether movementof the distal end of robot arm 300 is within a predetermined thresholdfor purposes of transitioning system 100 to passive mode, as describedin further detail below.

Trocar position detection module 1420 may be executed by processor 1402for determining the position and/or orientation of one or more trocarport inserted within the patient. The position and/or orientation of atrocar port may be derived based on data obtained from, e.g., inertialmeasurement units and/or accelerometers, optical scanners,electromechanical tracking instruments, linear encoders, the sensors anddata as described above. For example, the position of the trocar portson the patient may be determined using a laser pointing system that maybe mounted on one or more of the components of the system, e.g., wristportion 311 of the robot arm, and may be controlled by the system topoint to the optimal or determined position on the patient's body toinsert the trocar. Moreover, upon insertion of the surgical instrumentthat is attached to robot arm 300 through a trocar, virtual lines maycontinuously be established along the longitudinal axis of the surgicalinstrument, the alignment/orientation of which may be automaticallydetermined upon attachment of the surgical instrument to couplerinterface 400 via the coupler body via the magnetic connection asdescribed above, in real time as the surgical instrument moves about thetrocar point. Moreover, when the surgical instrument is inserted withinthe trocar port, it will be pointing toward the trocar point, andaccordingly, distal wrist link 316 will also point toward the trocarpoint, the angle of which may be measured by an encoder associatedtherewith. Accordingly, the trocar point may be calculated as theintersection of the plurality of virtual lines continuously establishedalong the longitudinal axis of the surgical instrument. In this manner,the calculated trocar point will remained fixed relative to the patientas the surgical instrument is maneuvered about the trocar port, e.g.,rotated or moved in or out of the patient. In addition, the orientationof the trocar port and its position relative to robot arm 300 may bedetermined based on image data received from one or more opticalscanners, e.g., a LiDAR camera and/or an RGBD camera. By measuring thetrue position and orientation of the trocar ports, the system may beprovided an additional safety check to ensure that the system levelcomputations are correct, e.g., to ensure that the actual motion of therobot arms or instrument matches a commanded motion of the robot arms orinstrument in robotic assist mode.

Based on the known position and/or orientation of a trocar port inaddition to the known position of the distal end of robot arm 300 fromrobot arm position determination module 1418, the system may maintainthe position of the distal end of robot arm 300 relative to the trocarpoint as robot arm 300 moves, e.g., via vertical or horizontaladjustment thereof by platform 200, or as the patient table height isadjusted, thereby causing the height of the patient's abdomen to move,thereby keeping the surgical instrument within the patient's body andcoupled to robot arm 300 steady during these external movements. Toachieve this, the known position of the distal end of robot arm 300 fromrobot arm position determination module 1418 is calculated in the globalframe of the system by adding position of platform 200 to the kinematicscalculations (e.g., the “forward kinematics” of robot arm 300 in thecontext of serial chain robotic manipulators).

With the position of the distal end of robot arm 300 known globally, thesystem may hold that position steady by applying appropriate forces torobot arm 300 during the external movements that minimize the errorbetween its current and desired positions. Accordingly, for example,when a surgical instrument coupled to the distal end of robot arm 300 isinserted through a trocar port such that the tip of the instrument isinside of the patient, and a user adjusts the height of the patienttable, the system may apply forces/torques to robot arm 300 toreconfigure robot arm 300 and/or cause movement of the stages ofplatform 200 to maintain the relative position between the distal end ofrobot arm 300, and accordingly the surgical instrument, and the trocarport. In some embodiments, the system may cause the distal end of robotarm 300 to retract slightly such that the tip of the surgical instrumentis positioned within the trocar port and out of contact with anatomicalstructures within the patient's body prior to reconfiguring robot arm300 to maintain the relative position between the surgical instrumentand the trocar port.

Force detection module 1422 may be executed by processor 1402 fordetecting forces applied on robot arm 300, e.g., at the joints or linksof robot arm 300 or along the surgical instrument, as well as applied onthe trocar, e.g., body wall forces. For example, force detection module1422 may receive motor current measurements in real time at each motor,e.g., M1, M2, M3, disposed within the base of robot arm 300, which areeach operatively coupled to a joint of robot arm 300, e.g., base joint303, shoulder joint 318, elbow joint 322, wrist joint 332. The motorcurrent measurements are indicative of the amount of force applied tothe associated joint. Accordingly, the force applied to each joint ofrobot arm 300 as well as to the surgical instrument attached thereto maybe calculated based on the motor current measurements and the positiondata generated by robot arm position determination module 1418 and/ortrocar position detection module 1420.

Due to the passive axes at the distal end of robot arm 300, the forceapplied by the instrument coupled with the robot arm on the trocar mayremain generally consistent throughout the workspace of the robot arm.The force on the trocar may be affected by the interaction of the distaltip of the instrument with tissue within the body. For example, if atissue retractor advanced through the trocar is engaged with (e.g.,grasping) bodily tissue or another object inside the body, the forceexerted on the end of the instrument from the bodily tissue or otherobject may cause a change in the force applied to the trocar. In someaspects, the force on the trocar may be a function of how much weight isbeing lifted by the instrument being used.

Impedance calculation module 1424 may be executed by processor 1402 fordetermining the amount of impedance/torque needed to be applied torespective joints of robot arm 300 to achieve the desired effect, e.g.,holding robot arm 300 in a static position in the passive mode,permitting robot arm 300 to move freely while compensating for gravityof robot arm 300 and the surgical instrument attached thereto in theco-manipulation mode, applying increased impedance to robot arm 300 whenrobot arm 300 and/or the surgical instrument attached thereto is withina predefined virtual haptic barrier in the haptic mode, etc.

For example, impedance calculation module 1424 may determine the amountof force required by robot arm 300 to achieve the desired effect basedon position data of robot arm 300 generated by robot arm positiondetermination module 1418 and the position data of the trocar generatedby trocar position detection module 1420. For example, by determiningthe position of the distal end of robot arm 300, as well as the point ofentry of the surgical instrument into the patient, e.g., the trocarposition, and with knowledge of one or more instrument parameters, e.g.,mass and center of mass of the surgical instrument stored by surgicalinstrument calibration module 1414, impedance calculation module 1424may calculate the amount of force required to compensate for gravity ofthe surgical instrument (compensation force), as described in furtherdetail below with regard to FIG. 23A. Accordingly, the amount ofcompensation force required to compensate for the gravity of thesurgical instrument may be converted to torque to be applied at thejoints of robot arm 300, e.g., by the motors operatively coupled to thejoints of robot arm 300, as indicated by the motor current measurements.

Moreover, by determining the position of the distal end of robot arm300, and accordingly, a change in position of the distal end of robotarm 300 over time, for example, due to an external force applied to thedistal end of robot arm 300, e.g., by tissue held by the operating endof the surgical instrument, and with knowledge of one or more instrumentparameters, e.g., mass, center of mass, and length of the surgicalinstrument stored by surgical instrument calibration module 1414,impedance calculation module 1424 may calculate the amount of forcerequired to maintain the surgical instrument in a static position (holdforce), as described in further detail below with regard to FIG. 23B.Accordingly, the amount of hold force required to resist the change inposition of the distal end of robot arm 300, in addition to the amountof compensation force required to compensate for the gravity of thesurgical instrument, may be converted to torque to be applied at thejoints of robot arm 300 to maintain robot arm 300 in a static position,e.g., by the motors operatively coupled to the joints of robot arm 300,as indicated by the motor current measurements. In addition, impedancecalculation module 1424 and/or force detection module 1422 may calculatethe amount of force applied by the surgical instrument to the patient atthe point of entry, e.g., at the trocar, as well as the amount of forceapplied to the operating end of the surgical instrument, e.g., thegrasper end of a surgical instrument, based on the compensation force,the hold force, one or more parameters of the surgical instrument suchas the mass, center of mass, and length of the surgical instrument, andthe distance from the center of mass to the point of entry.

Additionally or alternatively, by determining the forces applied onrobot arm 300 via force detection module 1422, as well as theposition/velocity/acceleration of the distal end of robot arm 300 in 3Dspace via robot arm position determination module 1418, the desiredforce/impedance to be applied to robot arm 300 to compensate for theapplied forces may be calculated, e.g., for gravity compensation or tohold robot arm 300 in a static position in the passive mode.Accordingly, the desired force may be converted to torque to be appliedat the joints of robot arm 300, e.g., by the motors operatively coupledto the joints of robot arm 300. For example, the robot Jacobian may beused for this purpose.

Motor interface module 1426 may be executed by processor 1402 forreceiving motor current readings at each motor, e.g., M1, M2, M3, M4,disposed within the base of robot arm 300, and for actuating therespective motors, e.g., by applying a predetermined impedance toachieved the desired outcome as described herein and/or to cause thejoints operatively coupled to the respective motors to move, such as inthe robotic assist mode. For example, motor interface module 1426 mayactuate M4 to cause rotation of distal shoulder link 308 relative toproximal shoulder link 306.

As described above, the data streams from the robot arms, the camerafeed from the laparoscope, the data acquired from optical scanner 202and/or proximity sensors 212, as well as data optionally captured fromone or more imaging devices disposed on a structure adjacent to therobot arms, the walls, ceiling, or other structures within the operatingroom, may be recorded, stored, and used individually or in combinationto understand and control the surgical system and procedures of thesurgical system. The foregoing components, devices, and combinationsthereof are collectively referred to herein as optical scanners oroptical scanning devices.

Optical scanner interface module 1428 may be executed by processor 1402for receiving depth data obtained by an optical scanning device, e.g.,optical scanner 202, and processing the depth data to detect, e.g.,predefined conditions therein. Moreover, optical scanner interfacemodule 1428 may generate depth maps indicative of the received depthdata, which may be displayed to the operator, e.g., via a monitor. Basedon the depth map generated by the optical scanning devices, opticalscanner interface module 1428 may cluster different groups of (depth)pixels into unique objects, a process which is referred to as objectsegmentation. Examples of such algorithms for segmentation may include:matching acquired depth map data to a known template of an object tosegment; using a combination of depth and RGB color image to identifyand isolate relevant pixels for the object; and/or machine learningalgorithms trained on a real or synthetic dataset to objects to identifyand segment. Examples of such segmentation on a depth map may include:locating the robot arms or determining the position of the robot arms;identifying patient ports (e.g., trocar ports) in 3D space anddetermining a distance from the instruments to the trocar ports;determining the relative distances between, e.g., the stages of platform200, robot arm 300, any surgical instruments attached thereto, andobjects/persons in the operating room such as the surgical table,drapes, etc.; identifying the surgeon and distinguishing the surgeonfrom other operators in the room; and/or identifying the surgeon in thesensor's field of view. Moreover, the system may use object segmentationalgorithms to uniquely identify the surgeon and track the surgeon withrespect to, for example, a surgical table, a patient, one or more robotarms, etc. In addition, the system may use object segmentationalgorithms to determine if a surgeon is touching or handling either ofthe robot arms and, if so, identify which robot arm is being touched orhandled by the surgeon.

Optical scanner interface module 1428 further may use objectsegmentation algorithms to analyze image data obtained from alaparoscope to locate and track one or more surgical instruments and/oranatomical structures and distinguish the tracked surgical instrument(s)and/or anatomical structure(s) from other objects and structures withinthe field of view of the laparoscope. For example, the objectsegmentation algorithms may include deep learning approaches.Specifically, a neural network may be trained for instrument/anatomicalstructure detection via a manually annotated video dataset sampled frommultiple laparoscopic surgeries includes various surgical instrumentsand anatomical environments. For example, as shown in FIG. 17A, labeledtraining data including manual annotations indicative of surgicalinstrument/anatomical structure locations as well as class labelsindicative of surgical instrument/anatomical structure type may be fedthrough a feature extractor to train the neural network to generateclass labels and identify surgical instrument/anatomical structurelocation within an image dataset. The trained neural network may then beimplemented by the system to detect the target surgicalinstrument/anatomical structure in image data obtained by thelaparoscope via optical scanner interface module 1428 in real time toprovide instrument centering as described in further detail below.

Optical scanner interface module 1428 further may receive image datafrom additional optical scanning devices as defined herein, includingfor example, an endoscope operatively coupled to the system. Moreover,optical scanner interface module 1428 may receive depth data obtained byproximity sensors 212 coupled to platform 200 and process the depth datato generate a virtual map of the area surrounding platform 200, asdescribed below with regarding to FIG. 33 , which may be displayed tothe operator via a monitor, e.g., display 210. For example, opticalscanner interface module 1428 may generate graphical representations ofsystem 100 including platform 200 and robot arms 300 a, 300 b, and anyobjects and/or persons within the area surrounding platform 200 fordisplay in the virtual map to guide movement of platform 200 and robotarms 300 a, 300 b through the operating room.

Gesture detection module 1430 may be executed by processor 1402 fordetecting predefined gestural patterns as user input, and executing anaction associated with the user input. The predefined gestural patternsmay include, for example, movement of a surgical instrument (whether ornot attached to robot arm 300), movement of robot arm 300 or othercomponents of the system, e.g., foot pedal, buttons, etc., and/ormovement of the operator in a predefined pattern. For example, movementof the surgical instrument back and forth in a first direction (e.g.,left/right, up/down, forward/backward, in a circle) may be associatedwith a first user input requiring a first action by the system and/orback and forth in a second direction (e.g., left/right, up/down,forward/backward, in a circle) that is different than the firstdirection may be associated with a second user input requiring a secondaction by the system. Similarly, pressing the foot pedal or a buttonoperatively coupled with the system in a predefined manner may beassociated with a third user input requiring a third action by thesystem, and movement of the operator's head back and forth or up anddown repeatedly may be associated with a fourth user input requiring afourth action by the system. Various predefined gestural patternsassociated with different components or operators of the system may beredundant such that the associated user input may be the same fordifferent gestural patterns. The predefined gestural patterns may bedetected by, e.g., an optical scanning device such as a laparoscope oroptical scanner 202 via optical scanner interface module 1428 ordirectly by force applied to robot arm 300 via force detection module1422 or other components of the system.

Actions responsive to user input associated with predefined gesturalpatterns may include, for example, enabling tool tracking to servo(i.e., move) the laparoscope based on the motion of a handheld tooland/or automatically to maintain the handheld tool within a field ofview of the laparoscope; engaging the brakes on (e.g., preventingfurther movement of) the robot arm; engaging a software lock on therobot arm; dynamically changing the length of time that the robot armtakes to transition between states from a default setting; loading avirtual menu overlay on the video feed whereby a surgical instrument inthe field of view of the laparoscope functions as a pointer to triggerfurther actions available from the virtual menu; start/stop a recordingof image data; and/or identifying which member of the surgical staff istouching the robot arm, if any. This information may be used to ensurethat the system does not move if the surgeon is not touching the robotarm, e.g., to avoid the scenario where an external force is acting onthe robot arm (e.g., a light cable or other wire being pulled across therobot arm) and the system perceives the force to be intentional from thesurgeon. The same information may be used to detect the gaze directionof the surgeon, e.g., whether the surgeon is looking at the video feedor somewhere else in the room, such that the system may freeze the robotarm if the surgeon's gaze is not in the direction it should be.Additionally, the system may reposition a field of view of a camerabased on, for example, the direction a surgeon is facing or based on theobjects that the surgeon appears to be looking at, based on the datafrom the optical scanner 1100. Moreover, moving the distal tip of asurgical instrument to a center portion of the laparoscopic field ofview, e.g., defined by a predetermined boundary region, and holding theposition for more than a predetermined time threshold may be associatedwith a user input detected by gesture detection module 1430 to enabletook tracking, as described in further detail below.

Moreover, a predefined gestural pattern such as double-tapping a distalportion of the robot arm and/or a predetermined sinusoidal movement ofthe camera head of the laparoscope about the trocar may be associatedwith a user input detected by gesture detection module 1430 to startand/or stop a recording of image/audio data by the optical scanningdevices. Specifically, there may be key moments during a procedure thatthe user may want recorded, and which the user may want to be able tolocate in a quick manner without having to go through an entirerecording of the entire procedure to find the key moments. By providingan easy way for the user to initiate and stop a recording via simplepredefined gestural patterns, such that the recording is saved to afolder with a timestamp associated with that particular procedure, theuser may easily locate the recording for review and/or teachingpurposes. This feature may be particularly useful for diagnosticprocedures. In some embodiments, in response to detection of thepredefined gestural pattern by gesture detection module 1430, the systemmay record and save a predetermined portion of the image data, e.g., tenseconds before and ten seconds after the predefined gestural pattern isdetected. Moreover, the select recordings of key moments by the user maybe used by the system to indicate key phase segmentation for a givenprocedure. The user further may generate case notes via the recordings,e.g., by indicating progression through different phases of a procedurewhen performing a procedure based on a template of the procedureaccessible via the system.

As described above, responsive to detection of a predefined gesturalpattern by the user, e.g., a predefined pattern of movement of thedistal tip of the surgical instrument within the field of view of thelaparoscope, gesture detection module 1430 may cause a virtual menu tooverlay on the video feed, such that the surgical instrument within thefield of view of the laparoscope functions as a pointer, as shown inFIG. 15 . Moreover, gesture detection module 1430 may detect furtherpredefined patterns of movement of the distal end of the surgicalinstrument, e.g., two quick movements in the same direction or acircular movement over a select area of the virtual menu, which may beinterpreted as a selection actuation, e.g., a click on the virtual menu.For example, as shown in FIG. 15 , the virtual menu overlay on the videofeed may include menu options in the corners of the video feed, e.g.,“hot corners”, such as: turning on/off instrument centering mode wherethe system automatically moves the robot arm coupled to a laparoscope tofollow the surgical instrument and/or zoom in or out to change the fieldof view of the laparoscope and maintain the target instrument within apredetermined reference distance from the tip of the laparoscope;adjusting the holding force of robot arm coupled to a retractor, e.g.,the amount of force that may be applied to the distal tip of thesurgical instrument before the system transitions from passive mode toco-manipulation mode; turning on/off audio; and turning on/off hapticfeedback. As will be understood by a person having ordinary skill in theart, more or less menu options may be provided via the virtual menu.

In some embodiments, initiation of the display of the virtual menuoverlay on the video feed may be triggered by, e.g., actuation of anexternal actuator such as a foot pedal, a predefined pattern of forceapplied to the robot arm such double tapping wrist portion 311 and/orthe surgical instrument coupled to the robot arm as detected by encodersat the distal end of the robot arm, voice activation, wireless buttons,hot buttons, etc. In some embodiments, the operator may actively switchthe system to a command mode, e.g., via user interface 1408, whereparticular movements or gestures of the robot arm, surgical instrument,operator, or otherwise as described herein are monitored by gesturedetection module 1430 to determine if they are consistent with apredefined gestural pattern associated with a predefined user input.

Passive mode determination module 1432 may be executed by processor 1402for analyzing the operating characteristics of robot arm 300 todetermine whether to switch the operational mode of robot arm 300 to thepassive mode where the system applies impedance to the joints of robotarm 300 via motor interface module 1426 in an amount sufficient tomaintain robot arm 300, and accordingly a surgical instrument attachedthereto, if any, in a static position, thereby compensating for mass ofrobot arm 300 and the surgical instrument, and any other external forcesacting of robot arm 300 and/or the surgical instrument. If robot arm 300is moved slightly while in the passive mode, but not with enough forceto switch out of the passive mode, the system may adjust the amount ofimpedance applied the robot arm 300 to maintain the static position, andcontinue this process until robot arm 300 is held in a static position.For example, passive mode determination module 1432 may determine toswitch the operational mode of robot arm 300 to the passive mode ifmovement of the robot arm due to movement at the handle of the surgicalinstrument as determined by force detection module 1422 is less than apredetermined amount, e.g., no more than 1 to 5 mm, for at least apredetermined dwell time period associated with robot arm 300. Thepredetermined dwell time period refers to the length of time that robotarm 300 and/or the surgical instrument attached thereto, if any, areheld in a static position. For example, the predetermined dwell time mayrange between, e.g., 0.1 to 3 seconds or more, and may be adjusted bythe operator. FIG. 16 illustrates a table or exemplary values of thethreshold dwell times for a range of sample instrument types.

In some embodiments, passive mode determination module 1432 maydetermine to switch the operational mode of robot arm 300 to the passivemode if movement of the distal end of the robot arm due to movement atthe handle of the surgical instrument as determined by force detectionmodule 1422 has a velocity that is less than a predetermined dwellvelocity/speed. For example, if passive mode determination module 1432determines that the distal end of the robot arm 300 and/or the surgicalinstrument attached thereto, if any, moves at a speed that is lower thanthe predetermined dwell speed during an entire predetermined dwellperiod, then passive mode determination module 1432 may switch theoperational mode of robot arm 300 to the passive mode. FIG. 16illustrates a table or exemplary values of the threshold dwell speedsfor a range of sample instrument types. For example, for surgicalinstruments such as scopes and tissue manipulation devices, thethreshold dwell speeds may be, e.g., 3-5 mm/second, and for surgicalinstruments such as suturing instruments, needle drivers, high forceinstruments, staplers, and clip appliers, the threshold dwell speeds maybe, e.g., 1-2 mm/second. In some embodiments, passive mode determinationmodule 1432 may determine to switch the operational mode of robot arm300 to the passive mode based on the identity of the surgical instrumentupon attachment of the surgical instrument to robot arm 300 and/orresponsive detachment of the surgical instrument from robot arm 300.

Co-manipulation mode determination module 1434 may be executed byprocessor 1402 for analyzing the operating characteristics of robot arm300 to determine whether to switch the operational mode of robot arm 300to the co-manipulation mode where robot arm 300 is permitted to befreely moveable responsive to movement at the handle of the surgicalinstrument for performing laparoscopic surgery using the surgicalinstrument, while the system applies an impedance to robot arm 300 viamotor interface module 1426 in an amount sufficient to account for massof the surgical instrument and robot arm 300. Moreover, the impedanceapplied to robot arm 300 may provide a predetermined level of viscosityperceivable by the operator. FIG. 16 illustrates a table or exemplaryvalues of viscosity levels for a range of sample instrument types. Insome embodiments, the viscosity level may be a function of the speedthat the surgical instrument is being moved and the distance of the tipof the instrument from the trocar point. For example, co-manipulationmode determination module 1434 may determine to switch the operationalmode of robot arm 300 to the co-manipulation mode if force applied atrobot arm 300 due to force applied at the handle of the surgicalinstrument exceeds a predetermined threshold associated with robot arm300 (e.g., a “breakaway force”). The predefined force threshold may be,e.g., at least 7 Newtons, approximately 7 Newtons, at least 7 Newtons,4-15 Newtons, 4-10 Newtons. The predefined force threshold may bedependent on the type of surgical instrument that is being used and/orwhether there is an external force being applied to the surgicalinstrument.

FIG. 16 illustrates a table or exemplary values of the predefined forcethresholds for a range of sample instrument types. As shown in FIG. 16 ,the predefined force thresholds may reflect the typical external tissueforces that may be exerted on the surgical instrument. In someembodiments, the predefined force threshold may be increased if a forceis exerted on the surgical instrument by tissue or an organ orotherwise, depending on the direction of the breakaway force. Forexample, if the breakaway force is in the same direction as the forceexerted on the surgical instrument from the tissue or organ, thepredefined force threshold may be increased by an amount equal to orcommensurate with the force exerted on the surgical instrument from thetissue or organ, as described in further detail below with regard toFIGS. 27A and 27B. In some embodiments, the predefined force thresholdfor a respective robot arm be adjusted based on a patient's body massindex (“BMI”). For example, a patient with a higher BMI may have aheavier liver that would likely exert a greater force on the instrument.Accordingly, the predefined force threshold may selected to be higherfor the patients with a higher BMI. Accordingly, the operation mayactuate a “high force mode,” e.g., via user interface 1408, wherepredefined force threshold is increased to accommodate for engaging withheavier tissue or organs. For example, the predefined force thresholdmay be selectively increased by 20-100% or more.

Moreover, the force exerted by the user on the surgical instrument andany external tissue forces applied to the surgical instrument may bedirectionally dependent. For example, if the force exerted by the useron the surgical instrument is in the same direction as an externaltissue force applied to the surgical instrument, the two forces may beadditive such that the amount of force exerted by the user on thesurgical instrument needed to overcome the predefined force thresholdmay be reduced by the magnitude of the external tissue force such that alower force than the predefined force threshold would be required toexit the passive mode and enter the co-manipulation mode. On the otherhand, if the force exerted by the user on the surgical instrument is ina direction opposite to an external tissue force applied to the surgicalinstrument, than the necessary amount of force exerted by the user onthe surgical instrument needed to overcome the predefined forcethreshold may be increased by the magnitude of the external tissue forcesuch that a higher force than the predefined force threshold would berequired to exit the passive mode and enter the co-manipulation mode.

In addition, if the force exerted by the user on the surgical instrumentis in a direction that is perpendicular to an external tissue forceapplied to the surgical instrument, than the necessary amount of forceexerted by the user on the surgical instrument needed to overcome thepredefined force threshold may not be affected by the magnitude of theexternal tissue force such that the necessary force exerted by the useron the surgical instrument needed to exit the passive mode and enter theco-manipulation mode will equal the predefined force threshold. Forother directions, the force vectors of the applied forces may be addedto or offset by the force vectors of the external tissue forces toovercome predefined force threshold values for the system or theparticular surgical instrument that is coupled with the robot arm,depending on the direction of the external tissue force, if any, and theforce applied by the user. In some embodiments, co-manipulation modedetermination module 1434 may determine to switch the operational modeof robot arm 300 to the co-manipulation mode based on the identity ofthe surgical instrument.

Haptic mode determination module 1436 may be executed by processor 1402for analyzing the operating characteristics of robot arm 300 todetermine whether to switch the operational mode of robot arm 300 to thehaptic mode where the system applies an impedance to robot arm 300 viamotor interface module 1426 in an amount higher than applied in theco-manipulation mode, thereby making movement of robot arm 300responsive to movement at the handle of the surgical instrument moreviscous in the co-manipulation mode. For example, haptic modedetermination module 1436 may determine to switch the operational modeof robot arm 300 to the haptic mode if at least a portion of robot arm300 and/or the surgical instrument attached thereto is within apredefined virtual haptic boundary. Specifically, a virtual hapticboundary may be established by the system, such that the robot arm orthe surgical instrument coupled thereto should not breach the boundary.For example, a virtual boundary may be established at the surface of thepatient to prevent any portion of the robot arms or the instrumentssupported by the robot arms from contacting the patient, except throughthe one or more trocars. Similarly, the virtual haptic boundary mayinclude a haptic funnel to help guide the instrument into the patient asthe operator inserts the instrument into a trocar port.

Moreover, a virtual haptic boundary, e.g., haptic shell, may beestablished at a predetermined distance surrounding the workspace toprevent over-extension of the robot arm away from the operation site, aswell as to minimize “runaway” of the robot arm. For example, after aninstrument is decoupled from the coupler body coupled to the robot arm,the magnet within the coupler body described above should return itsmaximum position away from the repulsion magnet within coupler interface400 to thereby indicate that the surgical instrument has been removed;however, if the magnet does not return to that position, the system maythink that the surgical instrument is still attached to the robot armand continue to compensate for the mass of the surgical instrument,thereby causing the distal end of the robot arm to “runaway,” e.g.,drift upward. Accordingly, the virtual haptic boundary may slow down thedrifting robot arm to avoid potential collision with other objects orpeople. For example, the virtual haptic boundary may set at chest-levelof a user to prevent the robot arm from colliding with the user's head.

Accordingly, based on position data of robot arm 300 and/or the surgicalinstrument coupled thereto, e.g., received by robot arm positiondetermination module 1418 and/or trocar position detection module 1420,haptic mode determination module 1436 may determine if robot arm 300and/or the surgical instrument is within the predefined virtual hapticboundary, and accordingly transition robot arm 300 to the haptic modewhere processor 1402 may instruct associated motors to apply aneffective amount of impedance to the joints of robot arm 300 perceivableby the operator to communicate to the operator the virtual hapticboundary. Accordingly, the viscosity of robot arm 300 observed by theoperator will be much higher than in co-manipulation mode. In someembodiments, haptic mode determination module 1436 may determine toswitch the operational mode of robot arm 300 to the haptic mode based onthe identity of the surgical instrument.

Moreover, haptic mode determination module 1436 may generate temporarylocalized virtual haptic boundaries at the distal ends of the robot armsduring predetermined phases of a procedure/clinical workflow to prevent“runaway” and further enhance safety of the system. The predeterminedphases may include, e.g., during draping/tear-down of the drape,immediately after tool removal is detected, and/or immediately aftercoupler body removal is detected. For example, increasing viscosity ofthe robot arms during draping/tear-down may help stabilize the robotarms and prevent excessive movement/runaway thereof, and increasingviscosity during tool/coupler body removal may prevent “runaway” due toa force applied to the robot arm by the user during the removal process.The localized virtual haptic boundary may be temporary in that it mayonly be applied for a predetermined time period, e.g., a few secondsafter the predetermined phase is identified. The predetermined phases ofa procedure may be determined/estimated via, e.g., user input via GUI210 and/or voice command, uploaded from a database stored within thesystem, and/or via telemetry of the robot arms and identification and/orpositions of the surgical instruments. For example, the system maygather and analyze telemetry data regarding forces being applied to therobot arm to assess or estimate whether a user is attempting to remove atool from the robot arm, and accordingly, haptic mode determinationmodule 1436 may generate a temporary localized virtual haptic boundaryat the distal end of the robot arm to facilitate tool removal.

In addition, haptic mode determination module 1436 may adjust the amountof viscosity, e.g., impedance, applied at the distal ends of the robotarms during predetermined phases of a surgical procedure to guidespecific movements during the predetermined phase based on the type ofsurgical instrument coupled to the robot arm, e.g., wristed instrumentssuch as a needle driver or grasper, stapling devices, dissectiondevices, suturing devices, retraction devices such as a fan retractor,tissue removal devices such as a gallbladder bag, clip applier devices,etc. For example, during a suturing phase of a procedure, viscosity atthe distal end of the robot arm may be increased to provide more viscouscontrol to the user during operation of the suture device. Additionally,during a stapling phase of a procedure, viscosity at the distal end ofthe robot arm may be increased to provide very stiff grounding for forceapplication of the stapling device operated by the user. Accordingly,the increased viscosity may facilitate performance of a specificmovement by the user without actively moving the robot arm to performthe specific movement.

Robotic assist mode determination module 1438 may be executed byprocessor 1402 for analyzing the operating characteristics of robot arm300 to determine whether to switch the operational mode of robot arm 300to the robotic assist mode where processor 1402 may instruct associatedmotors via motor interface module 1426 to cause movement ofcorresponding link and joints of robot arm 300 to achieve a desiredoutcome. For example, robotic assist mode determination module 1438 maydetermine to switch the operational mode of robot arm 300 to the roboticassist mode if a predefined condition exists based on data obtainedfrom, e.g., optical scanner interface module 1428.

For example, robotic assist mode determination module 1438 may determinethat a condition exists, e.g., that one or more trocars are not in anoptimal position, for example, due to movement of the patient, such thatrobot arm 300 should be repositioned to maintain the trocar in theoptimal position, e.g., in an approximate center of the movement rangeof robot arm 300, thereby minimizing the risk of reaching a joint limitof the robot arm during a procedure. Thus, in robotic assist mode,processor 1402 may instruct system to reposition robot arm 300, e.g.,via vertical/horizontal adjustment by platform 100 or via the joints andlinks of robot arm 300, to better align the surgical instrumentworkspace.

Robotic assist mode determination module 1438 may determine that acondition exists, e.g., the distance between an object, e.g., capitalequipment or a member of the surgical staff other than the surgeon, androbot arm 300 reaches or falls below a predetermined threshold, based onimage data obtained from the laparoscope or optical scanner 202 viaoptical scanner interface module 1428, such that the robot arm should befrozen to avoid collision with the object. Thus, in robotic assist mode,processor 1402 may instruct robot arm 300 apply the brakes to slow downthe robot arm or inhibit or prevent movement within a predetermineddistance from the other object to thereby prevent the inadvertentmovement of the robot arm that may otherwise result from such acollision or inadvertent force.

Robotic assist mode determination module 1438 further may determine thata condition exists, e.g., robot arm 300 is in an extended position for aperiod of time exceeding a predetermined threshold during a surgicalprocedure, such that the robot arm should be repositioned to provide theuser more available workspace in the vicinity of the surgical instrumentcoupled to the extended robot arm. Thus, in robotic assist mode,processor 1402 may instruct the system to reposition robot arm 300,e.g., via vertical/horizontal adjustment by platform 100 and/or via thejoints and links of robot arm 300, to move robot arm 300 closer to thesurgical instrument.

In addition, robotic assist mode determination module 1438 may determinethat a condition exists, e.g., the field of view of a laparoscopecoupled to robot arm 300 or optical scanner 202 is not optimal for agiven surgical procedure, e.g., due to blocking by the surgeon orassistant or another component of the system, based on image dataobtained from the laparoscope or optical scanner 202 via optical scannerinterface module 1428, such that the robot arm coupled to thelaparoscope or optical scanner 202 should be repositioned or zoom in/outto optimize the field of view of the surgical site for the operator.Thus, in robotic assist mode, processor 1402 may instruct robot arm 300,either automatically/quasi-automatically or responsive to user input bythe operator, to move to reposition the laparoscope and/or cause thelaparoscope to zoom in or zoom out, or to increase a resolution of animage, or otherwise. For example, the user input by the operator may bedetermined by gesture detection module 1430, as described above, suchthat movement of the robot arm or a surgical instrument in a predefinedgestural pattern in a first direction causes the endoscope to increaseresolution or magnification and in a second direction causes theendoscope to decrease resolution or magnification, and movement inanother predefined gestural pattern causes the robot arm holding thelaparoscope to retract away from the patient's body.

In some embodiments, robotic assist mode determination module 1438 maydetermine that a condition exists, e.g., initiation of an “instrumentcentering” mode by the user and identification of a target surgicalinstrument such as a handheld tool within the field of view of thelaparoscope attached to the robot arm, such that the robot arm shouldswitch to robotic assist mode to provide assisted scope control tocenter the instrument within the field of view of the laparoscope. Forexample, as described above, positioning and maintaining the distal tipof a surgical instrument at a center portion of the laparoscopic fieldof view, e.g., defined by a predetermined boundary region, for more thana predetermined time threshold may be associated with a user inputdetected by gesture detection module 1430 to enable tool tracking of thesurgical instrument, such that robotic assist mode determination module1438 switches the robot arm attached to the laparoscope to the roboticassist mode to provide automated instrument centering. For example,robotic assist mode determination module 1438 may execute one or moremachine learning algorithms on the image data received from thelaparoscope to identify the target surgical instrument within the fieldof view of the laparoscope, e.g., by evaluating pixels of the image datareceived by the laparoscope and indicating if the pixels correspond tothe target surgical instrument, to thereby identify the target surgicalinstrument. The machine learning algorithms may be trained with adatabase of annotated image data of associated surgical instrumentsusing trained modules, such as convolution kernels. For example, themachine learning algorithms may pass convolution kernels across theimages and attribute a score indicative of the likelihood that a givenpixel, or group of pixels, is correctly identified/classified. The scoremay be derived from a feature map generated by the kernels. By trainingthe machine learning algorithms on more data, the algorithms may beimproved by updating the weights in the kernels. As will be understoodby a person having ordinary skill in the art, other machine learningalgorithms may be used, e.g., pattern matching.

In the robotic assist mode, robotic assist mode determination module1438 may determine one or more conditions exist, e.g., the targetsurgical instrument within the field of view of the laparoscope movesout of a predefined boundary region, e.g., a predefined rectangular orcircular region about a center point of the field of view, within thefield of view indicating that the robot arm should reposition thelaparoscope to maintain the target surgical instrument within thepredefined boundary region within the field of view of the laparoscope,and/or the resolution of the target surgical instrument in thelaparoscope feed falls below a predetermined resolution thresholdindicating that the robot arm should move the laparoscope to zoom out,and/or the detected size of the surgical instrument falls below apredetermined size threshold indicating that the robot arm should movethe laparoscope to zoom in. In some embodiments, the predefined boundaryregion may be a selected fraction of the field of view, e.g., the innertwo-thirds of the field of view of the laparoscope. Thus, movement ofthe target surgical instrument within the predefined boundary region maynot cause movement of the robot arm, and accordingly movement of thelaparoscope; whereas, movement of the target surgical instrument outsideof the predetermined boundary region causes the robot arm to move thelaparoscope to maintain the target surgical instrument within thepredefined boundary region within the field of view of the laparoscope.Further, upon initiation of the instrument centering mode by the systemto track a handheld surgical instrument within the field of view of thelaparoscope, using object segmentation to distinguish surgicalinstruments when more than one surgical instrument is within the fieldof view of the laparoscope, the system may disregard non-target surgicalinstruments, e.g., surgical instrument(s) coupled to a robot arm withinthe field of view of the laparoscope, and track only the target surgicalinstrument, e.g., the handheld surgical instrument within the field ofview of the laparoscope.

Moreover, robotic assist mode determination module 1438 may determineone or more conditions exist, e.g., the surgical procedure beingperformed by the operator enters a known phase of the surgical procedureindicating that the laparoscope should focus on a specific surgicalinstrument and/or a specific anatomical structure. As described above,the system may use object segmentation to identify anatomical structureswithin the field of view of the laparoscope during a procedure, suchthat upon detection of a specific surgical instrument/anatomicalstructure, the system may determine that the surgical procedure hasentered a known phase. For example, during a cholecystectomy procedure,upon detection and identification of the cystic duct and target artery,e.g., via object segmentation and an stored/online database, roboticassist mode determination module 1438 may determine that the laparoscopeshould track the cystic duct and the artery, e.g., such that surgicalclips may be applied, and therefore maintain the cystic duct and theartery within the field of view of the laparoscope during this knownphase of the cholecystectomy procedure. Accordingly, the system maycause the robot arm to cause movement of the laparoscope to center itsfield of view on the cystic duct and the artery. As will be understoodby a person having ordinary skill in the art, robotic assist modedetermination module 1438 may be trained to identify various phases ofvarious surgical procedures, such that the system may provide instrumentcentering to focus the field of view of the laparoscope on key surgicalinstruments and/or anatomical structures based on the phase of thesurgical procedure. Moreover, the system may provide automated centeringto focus the field of view of the laparoscope on key anatomicalstructures rather than a surgical instrument based on the type ofsurgical instrument identified within the field of view of thelaparoscope using any of the surgical instrument identification methodsdescribed herein. For example, if the surgical instrument is identifiedas a suture device, the system may provide assisted scope control tofocus the field of view of the laparoscope on the anatomicalstructure(s) being sutured rather than the suture device.

Trajectory generation module 1440 may be executed by processor 1402 forgenerating a trajectory from the current position of the distal end ofthe robot arm to a desired position of the robot arm, which will resultin moving the distal end of the laparoscope from its current position toa desired position to maintain the target surgical instrument within thefield of view of the laparoscope to thereby provide instrument centeringin the robotic assist mode. The generated trajectory is configured toprovide the robot arm precise control over the speed and smoothness ofthe motion of the laparoscope as it is moved along the trajectory.Specifically, as shown in FIG. 17B, the trajectory generation module1440 may query an online trajectory generation module trained with dataobtained from previous surgical procedures including of preferredtrajectories of various surgeons and associated surgical instrumentlocations to therein, to thereby generate the trajectory based on adetermined surgical instrument location within the field of view of thelaparoscope.

In some embodiments, the surgeon's preferences may be learned based ondata from past procedures and/or sensors collecting information aboutcurrent procedure including a surgeon's current pose, a surgeon'sheight, a surgeon's hand preference, and other similar factors. Forexample, the system may record when a user interacts with the system andalso record what the user does with the system, such that the datasetmay allow for surgeon preferences to be “learned” and updated over time,as described below with regard to FIG. 37 . This learning may be doneeither via traditional algorithmic methods (i.e., trends over time,averaging, optical flow, etc.) or via machine learning approaches(classification, discrimination, neural networks, reinforcementlearning, etc.). For example, when the system provides instrumentcentering by tracking a surgical instrument within the field of view ofthe laparoscope, the operator at any time may “override” executed motionof the robot arm along the trajectory generated by trajectory generationmodule 1440 in the robotic assist mode, e.g., by applying a force to thehandle of the laparoscope that exceeds a predetermined force thresholdto cause the system to automatically switch the robot arm to theco-manipulation mode.

For example, the system may provide a predetermined override time periodwhere the user may manually move the laparoscope, e.g., to change thefield of view, clean the laparoscope, adjust the zoom, etc., and returnthe laparoscope to a stationary position before the system exitsinstrument centering mode. For example, the predetermined override timeperiod may be, e.g., 6 to 12 seconds, or preferably 8 seconds. Duringthe override time period, the user may adjust the reference distance,e.g., the distance between the tip of the laparoscope and the tip of thetarget instrument, by bringing the instrument tip to the desireddistance from the laparoscope for the laparoscope to follow once thetarget instrument is detected in the instrument centering mode. Uponexiting of the instrument centering mode, instrument centering mode maybe reentered via, e.g., actuation at GUI 210. Moreover, the overridingmotion of the robot arm may be recorded as the operator's preferredtrajectory given the current position of the target surgical instrument,such that the trajectory generation module associated with the givenoperator's surgeon profile may be updated to include the operator'spreferred trajectory. Moreover, as shown in FIG. 17B, the onlinetrajectory generation module may be updated/trained with data indicativeof the operator's preferred trajectory and associated surgicalinstrument location.

In addition, trajectory generation module 1440 may account for anangular offset between a camera sensor module, e.g., the camera head ofthe laparoscope, and the laparoscope coupled to the robot arm, e.g.,distal end of the robot arm, when generating the trajectory. Forexample, the camera head of the laparoscope may be attached to thelaparoscope at an arbitrary location relative to the robot coordinatesystem, with an unknown rotational position relative to the laparoscope.Thus, for an angled-tip laparoscope, movement of the robot arm along thegenerated trajectory will not result in the desired movement of thefield of view of the laparoscope when the laparoscope is not in theappropriate orientation relative to the laparoscope. For example, if thecamera head is upside-down relative to the laparoscope, movement of therobot arm that moves the laparoscope in the up direction will result ina shift of the field of view of the laparoscope in the down direction.Trajectory generation module 1440 may detect the angular offset betweenthe camera head and the distal end of the robot arm, as described infurther detail below with regard to FIG. 29 .

For example, trajectory generation module 1440 may detect the angularoffset by causing the robot arm to execute a predefined movementpattern, e.g., moving forward/backward and/or side-to-side, andcomparing the expected movement of a static object within the field ofview of the laparoscope, e.g., an anatomical structure or a surgicalinstrument, with the actual movement of the static object within thefield of view of the laparoscope. As will be understood by a personhaving ordinary skill in the art, a “static object” may be any objectwithin the field of view of the laparoscope which is generallyconsidered “static” with respect to the movement of the robot arm, andthus, may include objects in the background scene that move slightly dueto, e.g., respiratory motion, cardiac motion, etc. Based on the detectedoffset, trajectory generation module 1440 may calibrate the trajectorygeneration module to account for the offset and generate a calibratedtrajectory, such that movement of the laparoscope along the calibratedtrajectory will result in the expected shift of the field of view of thelaparoscope to maintain the target surgical instrument within the fieldof view of the laparoscope. In some embodiments, the system may includeone or more rotation sensors configured to detect the angular positionof the camera head relative to the laparoscope, and accordingly anangular offset, and thus would not need to execute the predefinedmovement pattern. Moreover, in some embodiments, additional image data,e.g., from optical scanner 202, indicative of movement of the proximalend of the laparoscope external to the patient may be used tofacilitation determination of the offset.

Similarly, trajectory generation module 1440 may account for positionaloffset of the attachment point of the coupler body along the shaft ofthe surgical instrument. For example, as described above, the couplerbody is preferably coupled to the instrument shaft at the proximal-mostpoint along the shaft, such that the distance between the distal end ofthe robot arm and the instrument tip may be known for the forcemeasurements described in further detail below. However, in the eventthat the coupler body is not attached at the proximal-most point alongthe instrument shaft, movement of the distal end of the robot arm maynot result in the desired movement of the instrument tip. Accordingly,the system may detect the positional offset of the coupler bodyattachment point, if any, and calibrate its force measurement algorithmsto account for the offset, such that movement of the distal end of therobot arm will result in the expected movement of the instrument tip.

Fault detection module 1442 may be executed by processor 1402 foranalyzing the data indicative of the operating characteristics of thesystem, e.g. position data generated by robot arm position determinationmodule 1418 and/or trocar position detection module 1420 and/or forcemeasurement calculated by force detection module 1422, to detect whethera fault condition is present. For example, fault detection module 1442may a fault condition of the system and determine whether the faultcondition is a “minor fault,” a “major fault,” or a “critical fault,”wherein each category of fault condition may be cleared in a differentpredefined manner.

For example, fault detection module 1442 may detect a minor faultcondition such as robot arm 300 being moved with a velocity exceeding apredetermined velocity threshold, which may be cleared, e.g., by slowingdown the movement of robot arm 300. In some embodiments, the system mayautomatically apply additional impedance to robot arm 300 when robot arm300 is moving too fast, e.g., a temporary localized virtual boundary, tothereby force the operator to slow down movement of robot arm 300. Thetemporary localized virtual boundary may be applied whether or not aninstrument is attached to the robot arm, but that the velocity of thedistal end of the robot arm exceeds a predetermined velocity threshold.Moreover, fault detection module 1442 may detect a major fault conditionsuch as an inadvertent bump of robot arm 300 as indicated by a largeforce applied to robot arm 300 by a person other than the operator. Inresponse to detection of a major fault condition, fault detection module1442 may actuate the braking mechanism associate with each motorizedjoint of robot arm 300 (or at least the joints associated with the majorfault condition), to thereby freeze robot arm 300 and inhibit furthermovement of robot arm 300. Such a major fault condition may be clearedby the operator actuating a “clear” option displayed on user interface1408. Fault detection module 1442 may detect a critical fault conditionsuch as redundant encoders associated with a given joint of robot arm300 generating different angulation measurements with a delta exceedinga predetermined threshold. In response to detection of a critical faultcondition, fault detection module 1442 may actuate the braking mechanismassociate with each motorized joint of robot arm 300 to thereby freezerobot arm 300 and inhibit further movement of robot arm 300. Such acritical fault condition may be cleared by the operator restarting thesystem. Upon restart of the system, if the critical fault condition isstill detected by fault detection module 1442, robot arm 300 will remainfrozen until the critical fault condition is cleared.

Indicator interface module 1444 may be executed by processor 1402 forcausing indicators 334 to communicate the state of the system, e.g., theoperational mode of robot arm 300, to the operator or other users, basedon, for example, determinations made by passive mode determinationmodule 1432, co-manipulation mode determination module 1434, haptic modedetermination module 1436, and/or robotic assist mode determinationmodule 1438. For example, indicator interface module 1444 may causeindicators 334 to illuminate in specific color light associated with aspecific state of the system. For example, indicator interface module1444 may cause indicators 334 to illuminate in a first color (e.g.,yellow) to indicate that no surgical instrument is attached to the robotarm, and that the robot arm may be moved freely such that the systemcompensates for the mass of the robot arm; in a second color (e.g.,purple) to indicate that a surgical tool is attached to the robot arm,and that the robot arm may be moved freely such that the systemcompensates for the mass of the robot arm and the mass of the surgicalinstrument coupled to the robot arm; in a third color (e.g., blue) toindicate that a surgical instrument is attached to the robot arm, andthat the robot arm is in the passive mode as determined by passive modedetermination module 1432; in a fourth color (e.g., pulsing orange) toindicate that at least a portion of the robot arm and/or the surgicalinstrument attached thereto is within the virtual haptic boundary, e.g.,1.4 m or more above the ground; in a fifth color (e.g., pulsing red) toindicate that a fault has been detected by the system by fault detectionmodule 1442. As will be understood by a person having ordinary skill inthe art, different colors and patterns may be communicated by indicators334 to indicate the states of the system described above.

Additionally, indicators 334 may be illuminated in other distinct colorsand/or patterns to communicate additional maneuvers by robot arm 300,e.g., when robot arm 300 retracts the surgical arm in the robotic assistmode, or performs another robotically-assisted maneuver in the roboticassist mode. As described above, indicators 334 further may includedevices for emitting other alerts such as an audible alert or textalert. Accordingly, indicator interface module 1444 may cause indicators334 to communicate the state of the system to the operator using audioor text, as well as or instead of light. For example, indicatorinterface module 1444 may cause one or more speakers to emit an audiblealert that changes in, e.g., amplitude and/or frequency, as robot arm300 approaches a potential collision with one or more objects/personswithin the operating room.

Additionally or alternatively, indicator interface module 1444 maycommunicate the state of the system, e.g., transition fromco-manipulation mode to passive mode, via haptic feedback at the distalend of robot arm 300, and accordingly on the surgical instrument coupledthereto. For example, when the surgical instrument is held in a positionfor the predetermined dwell time such that the system switches topassive mode, the user may feel a vibration at the surgical instrumentindicating that the system has transitioned to passive mode and that theuser may let go of the surgical instrument. As another example, the usermay feel a vibration after the surgical instrument is coupled to thecoupler body to indicate that the surgical instrument is successfullycoupled to the robot arm. The vibration may be strong enough to be feltby the user, but weak enough such that any movement at the distal tip ofthe surgical instrument resulting therefrom is negligible.

The co-manipulation surgical robot systems described herein may includeadditional modules within memory 1410 of platform 1400 for executingadditional tasks based on the data obtained. For example, the system maydetermine if the surgical instrument has been detached from robot arm300 based on data indicative of the position of the distal end of robotarm 300 relative to the trocar point generated by trocar positiondetection module 1420, as well as the direction of an instrument shaftand/or an orientation of the distal-most link of robot arm 300, e.g.,distal wrist link 316. For example, if the instrument is pointingdirectly at the trocar, then there is a higher probability that a toolis attached to the robot arm. Moreover, axis Q7 of robot arm 300 mayindicate the pointing direction of the instrument and, if the instrumentis passing through the trocar port, the distal wrist link 316 will pointin a direction of the trocar port. Therefore, if distal wrist link 316is not pointing toward the trocar port, then the system may determinethat the robot arm is not supporting an instrument or the instrument isnot advanced through the trocar port. For example, when an instrument isdetached from robot arm 300 and robot arm 300 is moved, the computeddirection of the instrument shaft (e.g., the direction that theinstrument would point if attached to robot arm 300) may no longer pointto the trocar entry point and likely will not point to the trocar entrypoint. Accordingly, the may alert a user if the system determines thatno tool is coupled with robot arm 300, e.g., via indicators 334, and/orapply a localized virtual haptic boundary to slow down the robot arm ifthe robot arm is moving in a single direction and there is no movementat Q7.

Referring now to FIG. 18 , operation 1800 of the co-manipulationsurgical robot systems described herein is provided. As shown in FIG. 18, at step 1802, the operator may couple a selected surgical instrumentto coupler interface 400 of robot arm 300 via a coupler body, e.g.,coupler body 500, 900. As described above, the operator may select acoupler body sized and shaped to couple with the selected surgicalinstrument, e.g., based on the elongated shaft diameter of the surgicalinstrument. When the surgical instrument and coupler body are ready tobe coupled to robot arm 300, the operator may load the calibration fileof the selected surgical instrument, e.g., via user interface 1408, suchthat information associated with the selected surgical instrument, e.g.,a laparoscope or retractor, is loaded into the system. For example, theoperator may select the calibration file from a database of calibrationfiles for a variety of surgical instruments. The calibration files maybe stored from previous procedures, and may be pre-loaded to includecalibration files of commonly used laparoscopic instruments.

Alternatively, as described above, the system may automatically identifythe surgical instrument upon attachment to the robot arm, andaccordingly, may automatically load the corresponding calibration file.For example, as described above, the system may identify at least theshaft diameter of the surgical instrument coupled to the coupler body(or that will be coupled to the coupler body) when the coupler body iscoupled to the coupler interface based on the specific magnetic fieldstrength measured by sensor 414 induced by the displaced magnet withinthe coupler body, which may be indicative of whether a 5 mm or 10 mmcoupler body is coupled to the coupler interface, with or without thesurgical instrument attached. Accordingly, the system may automaticallyload a calibration file associated with a surgical instrument having theidentified shaft diameter, which may be used to automatically calibratea surgical instrument in real-time via adaptive gravity compensation, asdescribed in further detail below with regard to FIG. 24 .

If the calibration file for the selected surgical instrument is notavailable in the database, the operator may self-calibrate the surgicalinstrument using the system. For example, FIG. 19 illustrates surgicalinstrument calibration process 1900 for calibrating a surgicalinstrument, e.g., to determine the center of mass of the surgicalinstrument, which may be used in calculating accurate force measurementson the surgical instrument and robot arm 300 during operation. At step1901, the operator may actuate the “startup” option on user interface1408. At step, 1902, the operator may select the “load tool calibration”to begin the calibration process. At step 1903, the system does notapply any impedance to robot arm 300 for gravity compensation of asurgical instrument. The system may apply impedance to robot arm 300 toaccount for the weight of robot arm 300, e.g., to prevent robot arm 300from dropping to the ground. At step 1904, the surgical instrument iscoupled to coupler interface 400 of robot arm 300 via the appropriatesized coupler body, which may cause wrist portion 411 of robot arm 300to rotate about axis Q7 to engage with the coupler body.

At step 1905, the system compensates for the gravity of the surgicalinstrument and the force applied by the hand of the operator, e.g., bymeasuring the force applied to the distal end of robot arm 300 due tothe mass of the surgical instrument. As described above, the forceapplied to the distal end of robot arm 300 may be measured by measuringthe motor current across the motors disposed in the base of robot arm300. If the system overcompensates for the gravity of the surgicalinstrument, at step 1906, robot arm 300 may “runaway”, e.g., driftupward. The runaway effect may be detected at step 1907, and at step1908, indicators 334 may blink to indicate to the operator of therunaway. At step 1909, the system may identify the runaway as a minorfault, and accordingly apply additional impedance to robot arm 300 andfreeze robot arm 300 when robot arm 300 slows down before removing theadditional impedance. Once the minor fault is addressed, calibrationprocess 1900 may return to step 1903.

After step 1905, when the system compensates for the gravity of thesurgical instrument, if the surgical instrument is detached, eitheraccidentally or manually by the operator at step 1911, at step 1910, thesystem detected the detachment of the surgical instrument from robot arm300. As a result, the system will stop compensating for the gravity ofthe surgical instrument, and calibration process 1900 may return to step1903. Moreover, as described above, the system may apply a temporarylocalized virtual haptic boundary at the distal end of the robot armupon detection of the detachment of the surgical instrument from robotarm 300. After step 1905, when the system compensates for the gravity ofthe surgical instrument, calibration process 1900 is ready to entercalibration mode at step 1912. For example, the operator may initiatecalibration mode via user interface 1408 at step 1913. At step 1914, thesystem may indicate to the operator, e.g., via user interface 1408and/or blinking of indicators 334, that it is safe to let go of surgicalinstrument, such that the operator may let go of the surgical instrumentat step 1916. At step 1915, the system calibrates the surgicalinstrument. As described above, provided that each specific make of asurgical instrument may have a distinguishable, precise mass, the makeof the surgical instrument may be determined by comparing the calibratedmass with a stored or online database of surgical instruments.Accordingly, a surgical instrument may be labeled as an unauthorizedsurgical instrument during calibration.

Referring again to FIG. 18 , when the surgical instrument and couplerbody are coupled to robot arm 300, and the appropriate calibration fileis loaded, the system will now accurately compensate for the gravity ofthe selected surgical instrument. At step 1804, the user may use theco-manipulation surgical system by freely manipulating the surgicalinstrument coupled to robot arm 300 in the ordinary manner that theoperator would without robot arm 300 coupled thereto. As shown in FIG.18 , as the operator manipulates the surgical instrument, andaccordingly robot arm 300 coupled thereto, the system may continuouslymonitor the robot arm and forces applied thereto to detect predefinedconditions and automatically switch between, e.g., co-manipulation mode1806, passive mode 1808, haptic mode 1810, and robotic assist mode 1812(collectively referred to as “operational modes”), upon detection of thepredefined conditions.

For example, as shown in FIG. 20 , at step 2002, the system continuouslycollects data related to a first operating characteristic of the robotarm and/or of the surgical instrument coupled with the robot arm. Forexample, as described above, the system may measure motor current of themotors operatively coupled to the joints of the robot arm as well asangulations of the links of the robot arm based on measurements by theencoders of the robot arm to calculate the positon of the robot arm andthe surgical instrument as well as the forces acting on any portion ofthe robot arm as well as on the surgical instrument, if any, in realtime. At step 2004, the system may analyze the data related to the firstoperating characteristic to determine if a first condition is present.For example, based on the position and force data of the robot armand/or surgical instrument, the system may determine if the movement ofthe robot arm due to movement of the surgical instrument coupled theretois within a predetermined movement threshold of the robot arm for aperiod of time longer than the predetermined dwell time of the robotarm. Upon detection of this first condition, at step 2006, the systemmay modify a first operating parameter of the robot arm. For example,the system may switch the operational mode of the robot arm to thepassive mode, where the robot arm maintains the surgical instrument in astatic position.

Referring again to FIG. 18 , the operational mode of any one of therobot arms may be changed independent of the operational mode of theother robot arms of the system. The sensors, motors, etc. of the systemmay be active in all modes, but may act very differently in each mode,e.g., including acting as if inactive. As will be understood by a personhaving ordinary skill in the art, the system may include more than tworobot arms, such that the operator may couple a third surgicalinstrument, e.g., a grasper device, to a third robot arm and a fourthsurgical instrument, e.g., a surgical scissor device, to a fourth robotarm for operation during the laparoscopic procedure. In addition, whenno surgical instrument is coupled to the distal end of a robot arm ofthe system, the system is still capable of automatically switching theoperational modes of the robot arm responsive to movement of the robotarm by an operator upon detection of the predefined conditions describedabove. Accordingly, the system will apply an impedance to the joints ofthe robot arm to compensate for the mass of the robot arm such that therobot arm may remain in a static position when in the passive mode, andwill permit the robot arm to be freely moveably by the operator in theco-manipulation mode if the system detects that the force applied to therobot arm by the operator exceeds the predetermined force threshold ofthe robot arm.

Moreover, as the operator freely moves the retractor in theco-manipulation mode, e.g., prior to inserting the tip of the retractorthrough the trocar within the patient, if the operator moves the tip ofthe retractor too close to the patient's skin away from the trocar port,and a virtual haptic boundary has been established by the system on theskin of the patient outside the trocar ports, the system mayautomatically switch to the haptic mode. Accordingly, the system mayapply an impedance to the second robot arm that is much higher than theimpedance applied to the second robot arm in co-manipulation mode toindicate to the operator that they are approaching or within the virtualhaptic boundary. For example, movement of the retractor by the operatormay feel much more viscous in the haptic mode. The system may remain inthe haptic mode until the operator moves the retractor out of thevirtual haptic boundary. In some embodiments, in the haptic mode, thesecond robot arm may reduce the effects of gravity, eliminate tremor ofthe instrument tip, and apply force feedback to avoid criticalstructures as defined by the virtual haptic boundary. Accordingly, thesystem does not replace the operator, but rather augments the operator'scapabilities through features such as gravity compensation, tremorremoval, haptic barriers, force feedback, etc.

In some embodiments, the system may switch the second robot arm to therobotic assist mode. For example, as the operator attempts to retractthe tissue, if more force is required to retract the tissue than theoperator is able or willing to apply to the retractor, the operator mayprovide user input to the system indicating that the operator wants thesecond robot arm to assist in the retraction of the tissue. For example,as described above, the operator may perform a predefined gesturalpattern that may be detected by, e.g., optical scanner 202, such thatthe system switches the second robot arm to the robotic assist mode andcauses the motors of the second robot arm to move the second robot arm,and accordingly the retractor, to provide the additional force requiredto retract the tissue.

In addition, instead of manually manipulating the laparoscope coupled tothe first robot arm as described, the operator may provide another userinput to the system indicating that the operator wants the system toreposition the laparoscope. For example, if the operator is activelymanipulating a surgical scissor, which may or may not be coupled to arobot arm of the system, such that the tip of the surgical scissor iswithin the field of view of the laparoscope coupled to the first robotarm, the operator may perform a predefined gestural pattern with the tipof the surgical scissor, e.g., moving the surgical scissor quickly backin forth in a particular direction. The predefined gestural pattern ofthe surgical scissor may be captured as image data by the laparoscope,and based on the data, the system may detect and associate thepredefined gestural pattern with a predefined user input requiring thatthe system switch the first robot arm from the passive mode to therobotic assist mode, and cause the first robot arm to reposition itself,and accordingly the laparoscope, to adjust the field of view in thedirection of the pattern motion of the surgical scissor, oralternatively, reposition itself to adjust the field of view to ensurethat the tip of the surgical scissors remain within an optimum positionwithin the field of view of the laparoscope during the procedure. Asdescribed above, additional gestural patterns may be performed via thesurgical scissor within the field of view of the laparoscope to causethe first robot arm to retract the laparoscope and/or to cause thelaparoscope itself to zoom in or zoom out or improve resolution.

In some embodiments, as described above, based on the image datacaptured by the laparoscope, using object tracking of the additionaltools in the field of view of the laparoscope, e.g., the surgicalscissors actively operated by the operator, the system may cause thefirst robot arm coupled to the laparoscope to switch to the roboticassist mode and cause the first robot arm to automatically repositionitself to adjust the field of view to ensure that the tip of thesurgical scissors remains within an predefined optimum position, e.g., aboundary region, within the field of view of the laparoscope during theprocedure.

For example, FIG. 21 illustrates exemplary instrument centering process2100 for tracking a surgical tool, e.g., the surgical scissors, withinthe field of view of the laparoscope. At step 2101, image data obtainedby the laparoscope is obtained by the system. For example, thelaparoscope may be any off-the-shelf laparoscope, and the camera controlunit of the laparoscope may be electrically connected to the system viaa video cable, e.g., HDMI, SDI, etc., such that the controller of thesystem may receive the image data from the laparoscope. At step 2103actuation of the instrument centering mode is detected by the system,e.g., via user input or automated actuated based on the detected phaseof the procedure. Step 2103 also may occur before or simultaneously withstep 2101. Upon actuation of the instrument centering mode, the systemdetermines whether a surgical instrument to be followed has beenselected at step 2104, e.g., manually via user input via GUI 210 orautomatically via detection of a predefined gestural pattern associatedwith user input of tool selection. For example, if a surgical instrumenthas not been selected, at step 2105, the user may perform a predefinedgestural pattern, e.g., move a surgical instrument to the center portionof the field of view of the laparoscope and hold the surgical instrumentin position for longer than a predetermined hold period, which isinterpreted by the system as user input of selecting to follow asurgical instrument. In addition, the distance between the tip of thesurgical instrument and the tip of the laparoscope may be established asthe reference distance, such that the robot arm may move the laparoscopeto maintain the surgical instrument within the field of view of thelaparoscope while also maintaining the reference distance between theinstrument and the laparoscope. Alternatively, in some embodiments, atstep 2104, the system may automatically select the surgical instrumentto be followed, e.g., via object segmentation and knowledge of thecurrent phase of the surgical procedure, as described above.Simultaneously, at step 2102, the system optionally may identify/predictif there is a primary tool for a given phase of the surgical procedure,which may be determined, e.g., based on one or more identified surgicalinstruments and/or anatomical features within the field of view of thelaparoscope, as described above.

If the system determines that a surgical instrument has been selected tobe followed at step 2104 and/or if the system identifies that there is aprimary tool for the given phase of the surgical procedure, at step2106, the system may determine whether the selected surgical instrumentis the primary tool for the given phase of the surgical procedure. Ifthe surgical instrument to be followed is not the primary tool, at step2107, the system determines whether it can successfully track theselected surgical instrument across consecutive images of thelaparoscope video feed. If the system determines that it can track theselected surgical instrument, the system proceeds to provide instrumentcentering at step 2108. If the system determines that the surgicalinstrument to be followed is the primary tool at step 2106, then at step2108, the system detects the selected surgical instrument within theimage data, e.g., a single image of the laparoscope video feed, andproceeds to provide instrument centering at step 2109.

At step 2110, the system continuously detects/follows/tracks thesurgical instrument within the field of view of the image data. Forexample, at step 2111, the system checks the scale, e.g.,resolution/size, of the surgical instrument within the image data, anddetermines at step 2112 whether or not the scale of the surgicalinstrument within the image data has changed. If the scale has notchanged, the system continues to detect/follow/track the surgicalinstrument within the image data. If the scale has changed, at 2113, thesystem may send a command to the robot arm to move the laparoscope,e.g., along the longitudinal axis of the laparoscope, to zoom in/outbased on the change of scale of the surgical instrument within the imagedata. For example, if the scale changes such that the size of thesurgical instrument increase, and thus, the resolution decreases, thecommand may be to zoom out, e.g., retract the laparoscope.

Simultaneously, at step 2114, the system checks the position of thesurgical instrument within the image data, and determines at step 2115whether or not the position of the surgical instrument within the imagedata has changed, e.g., moved outside of a predefined virtual boundaryregion within the field of view of the laparoscope. If the position hasnot changed, such that the surgical instrument, though moving, has notbeen detected to have moved outside of the predefined boundary region,the system continues to detect/follow/track the surgical instrumentwithin the image data. If the position has changed such that thesurgical instrument is detected to have moved outside of the predefinedboundary region, at 2116, the system may generate a trajectory, asdescribed above, and send a command to the robot arm to move thelaparoscope along the trajectory to a desired position to maintain thesurgical instrument within the predefined boundary region. For example,the command may cause the robot arm to move the laparoscope to aposition where the surgical instrument is at the center of thepredefined boundary region. Moreover, as described above, the system maycorrect for a detected angular offset between the camera head of thelaparoscope and the laparoscope in robotic assist mode to provideaccurate instrument centering.

As shown in FIG. 22 , an overlay of the tracked surgical instrument aswell as other tools within the field of view of the laparoscope may bedisplayed, e.g., via GUI 210, to indicate which tools are being trackedand which tools are not. Moreover, FIG. 22 illustrates boundary region2200, which may or may not be displayed as part of the overlay.

As described above, once the trajectory is determined, the systemcalculates the force required to apply at the joints of the robot arm tomove the robot arm, and accordingly the laparoscope, along thetrajectory. FIGS. 23A to 23B illustrates exemplary force measurements ofthe system during operation of robot arm 300. As described above, thecalibration file of the surgical instrument coupled to robot arm 300loaded on the system may include information of the surgical instrumentincluding, e.g., the mass of the surgical instrument, the center of massof the surgical instrument, and the length of the surgical instrument,such that distance D3 between the center of mass and the instrument tipmay be derived. In addition, as described above, the position of thesurgical instrument at the trocar, e.g., where the surgical instrumententers the patient's body, may be calculated in real-time, such thatdistance D2 between the center of mass of the surgical instrument andthe trocar may be derived in real time. Additionally, as describedabove, the coupler body is preferably coupled to the surgical instrumentat a fixed, known position along the elongated shaft of the surgicalinstrument (which may be included in the calibration file), e.g.,adjacent to the proximal portion of the surgical instrument, and thusdistance D1 between the center of mass of the surgical instrument andthe coupler body, e.g., the point of attachment to the distal end ofrobot arm 300, may be derived. Alternatively or additionally, asdescribed above, optical scanning devices may be used to determine anyone of D1, D2, or D3.

As shown in FIG. 23A, when the surgical instrument is positioned throughtrocar Tr, without any additional external forces acting on the surgicalinstrument other than at trocar Tr, e.g., the surgical instrument is notlifting or retracting tissue within the patient, the force applied tothe surgical instrument at trocar Tr by the body wall (e.g., the “bodywall force” or the “trocar force”) may be calculated with the followingequation:

F _(eff) +W+F _(tr)=0=>F ^(tr) =−W−F _(eff)

Where F_(eff) is the force at the distal end of robot arm 300 (e.g., the“end-effector force” of robot arm 300), W is the weight vector of thesurgical instrument (=−mgz), and F_(tr) is the trocar force.Accordingly, F_(eff) is the desired force sent to the system, which isthe sum of all the forces generated in the algorithm pipeline including,e.g., gravity compensation, hold, etc.

As shown in FIG. 23B, when the surgical instrument is positioned throughtrocar Tr and holding/retracting tissue, such that an external force isapplied to the tip of the surgical instrument, there are two forces toresolve: F_(tr) and F_(tt). Accordingly, two equations are needed tosolve for the two unknown vectors, which may be the balances of forcesand also the balance of moments around the center of mass of thesurgical instrument, e.g., L_(cg).

W+F _(eff) +F _(tr) +F _(tt)=0

F _(eff) ×D1+F _(tr) ×D2+F _(tt) ×D3=0

Here, distances D1 and D3 are known as described above, and D2 may bederived based on the known position of the distal end of robot arm 300and the calculated position of trocar Tr. As shown in FIG. 23B, thecenter of mass L_(cg) of the surgical instrument is behind the point ofattachment of the coupler body to the distal end of robot arm 300.

As described above, the system may alert the operator if the forces,e.g., force F_(tt) applied to the tip of the instrument and/or forceF_(tr) applied by the instrument at trocar Tr, are greater than therespective threshold forces, and accordingly freeze the system if thecalculated force is greater than the threshold force, and/or reduce theforce exerted at the trocar point at the body wall or at the tip of theinstrument by automatically applying brakes or stopping forces to robotarm 300, by slowing or impeding further movement of the instrument inthe direction that would increase forces applied at the tip of theinstrument or the trocar, and/or automatically moving the robotic arm ina direction that reduces the force being exerted at the instrument tipand/or at the trocar point at the body wall.

Accordingly, with knowledge of, e.g., the position of the trocar, thedistance from the coupler body to the instrument tip, the currentposition of the distal end of the robot arm, the current position of theinstrument tip, the desired position of the distal end of the robot armthat provides the desired position of the instrument tip, the system maycalculate the force required to apply to the distal end of the robot armto move it from its current position to its desired position to therebymove the instrument tip from its current position to its desiredposition. For example, when a robot arm is in passive mode, the desiredposition of the distal end of the robot arm/instrument tip will be thestatic position of the distal end of the robot arm/instrument tip whenpassive mode was initiated, and any forces below the breakaway forceapplied to the distal end of the robot arm, e.g., due to perturbations,may cause a change in the current position of the distal end of therobot arm/instrument tip. Accordingly, the system may calculate theforce required to apply to the distal end of the robot arm to move itfrom its current position to the desired static position (i.e., the“hold force”), and apply the requisite torque to the robot arm toeffectively maintain the robot arm in the desired static position inpassive mode.

Similarly, as shown in FIG. 23C, when the robot arm is in robotic assistmode where the system provides instrument centering, upon determinationof the trajectory for moving the distal end of the robot arm, andaccordingly, the laparoscope coupled thereto, between the currentposition and the desired position to maintain the tracked instrumentwithin the predefined boundary region within the field of view of thelaparoscope, the system may calculate the hold force required to applyto the distal end of the robot arm to move it from its current positionalong the trajectory to the desired position, and apply the requisitetorque to the robot arm to move the laparoscope and maintain the trackedinstrument within the predefined boundary region. As shown in FIG. 23D,when the trajectory required to move the laparoscope to maintain thesurgical instrument within the predefined boundary region only requiresa lateral movement, e.g., along an axis perpendicular to thelongitudinal axis of the laparoscope, the trocar position is notrequired, and the system may command the robot arm to move along thelateral trajectory to pan the field of view of the laparoscope.Similarly, as shown in FIG. 23E, when the trajectory required to movethe laparoscope to maintain the surgical instrument within thepredefined boundary region only requires a movement along thelongitudinal axis of the laparoscope, e.g., to zoom in/out, the trocarposition is not required, and the system may command the robot arm tomove along the longitudinal trajectory.

Moreover, as described above, the system may automatically calibrate asurgical instrument in real-time via adaptive gravity compensation,e.g., based on the hold forces required to maintain the robot arm in astatic position in passive mode. For example, an instrument's gravitycharacteristics may change dynamically at different locations and/orwith different attachments, e.g., scope cables, forces from thepatient's body wall, during operation of the robot arm. Accordingly, thesystem may update a calibration file of the surgical instrument inreal-time, e.g., in passive mode, to thereby dynamically adjust thegravity compensation applied by the system. FIG. 24 illustratesexemplary adaptive gravity compensation process 2400 for dynamicallyadjusting the gravity compensation applied by the system based onwhether the hold force is helping or opposing the applied gravitycompensation.

At step 2402, the system may automatically load a calibration fileassociated one or more known parameters of a surgical instrument coupledto the robot arm. For example, as described above, at least the shaftdiameter of the surgical instrument may be determined upon coupling ofthe coupler body to the coupler interface (with or without the surgicalinstrument attached), e.g., based on the specific magnetic fieldstrength induced by the displaced magnet within the coupler body.Additionally, or alternatively, image data captured by the opticalscanner(s) may be used to identify one or more known parameters of thesurgical instrument, e.g., the length and/or instrument type, and/ormeasured motor currents may be used to estimate the mass of theinstrument and/or a gravity category of the instrument such as “light,”“medium,” or “heavy.” Accordingly, the system may load a calibrationfile associated with the known parameter(s), e.g., a calibration fileassociated with a 5 mm or 10 mm surgical instrument. As will beunderstood by a person having ordinary skill in the art, varioussurgical instruments having the same shaft diameter also may have othersimilar parameters, such as mass, center of gravity, etc. Accordingly,the loaded calibration file may include one or more instrumentparameters that deviate from the actual parameters of the attachedsurgical instrument within an acceptable range. Moreover, the loadedcalibration file may be used to inform acceptable gravity compensationadjustments, as described in further detail below.

At step 2404, the system may apply gravity compensation to the robot armcoupled to the surgical instrument based on the instrument parameterswithin the loaded calibration file. For example, based on the mass ofthe surgical instrument stored in the calibration file (whether or notit is accurate), the system may calculate the amount of force to applyto the robot arm to compensate for the presumed weight of the surgicalinstrument and maintain the robot arm in a static position in passivemode, and apply the requisite torque to the robot arm to provide thegravity compensation.

At step 2406, the system may calculate the hold force required tomaintain the robot arm in a static position in passive mode. Preferably,the system continuously calculates the hold force while in passive mode;however, in some embodiments, the system may begin calculating the holdforce after a predetermined time period to ensure that the robot arm issteady in a static position, as described in further detail below withregard to FIGS. 26A to 26C. For example, when the surgical instrumentcoupled to the robot arm is not subjected to any external forces otherthan gravity in passive mode, e.g., by a trocar, tissue, and/or organ,if the instrument mass stored in the calibration file is equal to theactual mass of the surgical instrument coupled to the robot arm, thegravity compensation force applied by the system will completelycompensate for the weight of the instrument such that no extra force,i.e., hold force, is required to be applied to the robot arm to maintainthe robot arm in the desired static position. If the instrument massstored in the calibration file is less than the actual mass of thesurgical instrument coupled to the robot arm, the gravity compensationforce applied by the system will be less than needed to completelycompensate for the weight of the instrument such that the robot arm maydrift downward due to the actual weight of the instrument, requiring anupward hold force to be applied to the robot arm to maintain the robotarm in the desired static position. Similarly, if the instrument massstored in the calibration file is more than the actual mass of thesurgical instrument coupled to the robot arm, the gravity compensationforce applied by the system will be more than needed to completelycompensate for the weight of the instrument such that the robot arm maydrift upward due to the actual weight of the instrument, requiring adownward hold force to be applied to the robot arm to maintain the robotarm in the desired static position.

At step 2408, the system may determine one or more calibrated instrumentparameters for the surgical instrument, e.g., the mass and/or center ofmass of the surgical instrument, based on the calculated hold force, andupdate the calibration file accordingly. For example, the system maydetermine and update the mass of the surgical instrument within thecalibration file to a mass that corresponds with a gravity compensationforce that would result in no hold force being required to be applied tothe distal end of the robot arm to maintain the surgical instrument inthe desired static position, e.g., the updated mass is equal to theactual mass of the surgical instrument. As will be understood by aperson having ordinary skill in the art, the system may update and savethe loaded calibration file as a new calibration file associated withthe specific surgical instrument coupled to the robot arm and/or createa new calibration file for the specific surgical instrument.

At step 2410, the system may calculate and apply a subsequent, adjustedgravity compensation force to the distal end of the robot arm based onthe calibrated instrument parameter, e.g., the updated mass of thesurgical instrument, which will minimize the hold force required tomaintain the surgical instrument in the desired static position within apredetermined condition, e.g., by reducing the hold force to or nearzero. Moreover, the system may be programmed to only permit gravitycompensation adjustments within a predetermined range for a particularlysized instrument, e.g., based on the known shaft diameter upon couplingof the coupler body to the coupler interface. For example, if the systemknows that the instrument coupled to the robot arm is a 5 mm diameterinstrument, which is generally associated with a known range of masses,the mass of the instrument within the calibration file may be updated toa mass only within a predetermined range of the presumed mass within theloaded calibration file, such that gravity compensation also may only beadjusted within a predetermined range. Moreover, additional knownparameters, e.g., gravity category, instrument type, instrument length,etc., may also be associated with a respective known range of mass forthat particular parameter, to thereby limit the range of gravitycompensation adjustment for the particular surgical instrument. Inaddition, adjustments to the gravity compensation applied to the robotarm by the system may be applied gradually so as to avoid jumpy motionof the robot arm.

FIGS. 25A and 25B illustrate adaptive gravity compensation process 2400as applied to a robot arm coupled to a surgical instrument subjected toexternal forces in addition to gravity in passive mode. For example, asshown in FIG. 25A, at step 2404, the system may apply initial gravitycompensation force F_(grav_1) to the distal end of the robot arm coupledto the instrument, e.g., at location L_(eff), based on the mass of thesurgical instrument stored in the calibration file. Moreover, as shownin FIG. 25A, the tip of the instrument may be passed through trocar Tr,and engaged with tissue T, such that force F_(tt) is applied to the tipof the instrument by tissue T. At step 2406, the system may calculatehold force F_(hold_1) required to be applied to the distal end of therobot arm to maintain the tip of the instrument in the desired staticposition responsive to force F_(tt). For example, the system may onlyneed to calculate the vertical vector component of hold force F_(hold_1)along a vertical axis parallel to the direction of gravity based on thevertical vector component of force F_(tt).

At step 2408, the system may determine and update, e.g., the mass and/orcenter of mass L_(cg), of the instrument within the loaded calibrationfile to a mass and/or center of mass that corresponds with an increasedgravity compensation force that would result in a reduction of the holdforce required to be applied to the distal end of the robot arm tomaintain the surgical instrument in the desired static position.Accordingly, as shown in FIG. 25B, at step 2410, the system may apply asubsequent gravity compensation force F_(grav_2) to the distal end ofthe robot arm coupled to the instrument, e.g., at location L_(eff),based on the updated mass of the surgical instrument stored in thecalibration file to thereby reduce/minimize the hold force, e.g., holdforce F_(hold_2), required to maintain the surgical instrument in thedesired static position within a predetermined condition, e.g., based onknown acceptable ranges associated with a given instrument type. Forexample, the acceptable range within which the instrument parameters,and accordingly, gravity compensation, may be adjusted to reduce thehold force for a given instrument may be predetermined based on, e.g.,the known shaft diameter of the instrument, as described above.

Referring now to FIGS. 26A to 26C, as described above, the systempreferably continuously calculates the hold force while in passive mode;however, the system may establish a baseline hold force after apredetermined time period upon initiation of passive mode to ensure thatthe robot arm is steady in a static position, e.g., when one or moreexternal forces are applied to the instrument coupled to the distal endof the robot arm by one or more anatomical structures, e.g., tissue,bone, an organ, a body wall, etc. For example, under some circumstances,the hold force required to maintain the robot arm in the desired staticposition may require time to become steady upon initiation of passivemode and release of the surgical instrument by the user. For example,when the user operates the surgical instrument to engage a tissue, e.g.,to retract an organ, upon release of the instrument by the user, thehold force may gradually increase over time due to forces applied to thetip of the instrument by the tissue before becoming steady. Accordingly,the system may wait until the hold force has become steady, up to apredetermined time period upon initiation of passive mode.

Moreover, the rate/pattern of the change in the hold force over timeupon initiation of passive mode may further be indicative of whether theperturbations are due to, e.g., the instrument holding tissue or theuser repositioning the instrument. For example, a slow gradual increaseof hold force may indicate that the instrument is holding tissue inpassive mode; whereas, a change in hold force having a fluctuatingprofile may indicate that the user is still interacting with theinstrument and has not released the instrument, e.g., with forces lessthan the breakaway force. In addition, the system may temporarily changethe breakaway force of the robot arm to a predetermined, high value thatwould require a large amount of force to transition the robot arm frompassive mode to co-manipulation mode for at least the duration of thepredetermined time period before which the hold force is expected tobecome steady. Moreover, the system may set the hold force calculatedafter the predetermined time period as a baseline hold force, and adjustthe breakaway force based on the baseline hold force to compensate forotherwise large hold forces required to maintain a surgical instrumentin a desired static position in passive mode, as described in furtherdetail with regard to FIGS. 27A and 27B.

As shown in FIG. 26A, the hold force may gradually increase over time,e.g., due to one or more external forces applied to the instrument byone or more anatomical structures, upon initiation of passive mode,e.g., when hold is initially engaged, and eventually become steady. Asdescribed above, the system may apply a temporary high breakaway forceto the robot arm coupled to the instrument for a predetermined timeperiod upon initiation of passive mode until the baseline hold force isestablished, to thereby prevent inadvertent disengagement of the robotarm from passive mode. For example, the temporary breakaway force shouldbe high enough such that inadvertent bumps or other perturbations of therobot arm do not exceed the temporary breakaway force, but not so highthat a user could not manually disengage the robot arm from passive modevia the application of force.

As described above, the system may continuously calculate the hold forcerequired to maintain the distal end of the robot arm, and accordinglythe surgical instrument coupled thereto, in the desired static positionwhile in passive mode, and may calculate the average hold force afterthe predetermined time period upon initiation of passive mode, andestablish this value as the baseline hold force. As further describedabove, gravity compensation may be dynamically adjusted to therebyadjust the gravity compensation force to the robot arm and reduce thebaseline hold force within acceptable limits associated the surgicalinstrument. Accordingly, the baseline hold force may be the hold forcecalculated after the predetermined time period minus any reductions dueto increased gravity compensation. Moreover, the system may thenestablish the breakaway force based on the baseline hold force, e.g., asa value having a predetermined delta from the baseline hold force, asshown in FIG. 26A. Accordingly, the amount of additional force requiredto be applied to the surgical instrument to transition the robot armfrom passive mode to co-manipulation mode may be the same, e.g., delta,in all directions regardless of the amount of force being applied to theinstrument by a tissue/organ, as described in further detail with regardto FIGS. 27A and 27B. In addition, the system may continue to apply theadjusted gravity compensation while the robot arm is operated in theco-manipulation mode.

As shown in FIG. 26B, the hold force may having a fluctuating profileover time, e.g., due to perturbations and/or small user hand movementsbefore letting go of the instrument, following initiation of passivemode, e.g., when hold is initially engaged. As described above, thesystem may apply a temporary high breakaway force to the robot armcoupled to the instrument for a predetermined time period uponinitiation of passive mode, to thereby prevent inadvertent disengagementof the robot arm from passive mode. As shown in FIG. 26B, if the holdforce of the robot arm detected by the system continues to fluctuate atthe end of the predetermined time period while less than temporary highbreakaway force, the system may determine that a baseline hold forcecannot be established, and set a default breakaway force, e.g., notbased on a baseline hold force. Accordingly, when the force applied tothe surgical instrument reaches the default breakaway force, the systemwill disengage the hold and switch the robot arm from passive mode toco-manipulation mode.

As shown in FIG. 26C, if the hold force reaches/achieves the temporaryhigh breakaway force applied by the system within the predetermined timeperiod upon initiation of passive mode, the system will disengage thehold and switch the robot arm from passive mode to co-manipulation mode,as this movement is likely intended by the user. As described above, thesystem may be manually set to a “high force mode” by a user, e.g., viathe graphical user interface, where a predetermined higher breakawayforce is established for a given phase of a procedure. However, byautomatically adjusting the breakaway force based on the establishedbaseline hold force, the system may account for higher forces beingapplied to the instrument, e.g., via a heavy organ, in real-time inpassive mode, without requiring manual actuation of the “high forcemode.”

For example, FIG. 27A illustrates force F_(tt) applied to the tip of theinstrument by tissue T, the baseline hold force F_(hold_base) requiredto maintain the surgical instrument in the desired static positionresponsive to force F_(tt), and breakaway force F_(break_1) required tobe applied to the robot arm to exit the passive mode and enter theco-manipulation mode when the breakaway force is not established basedon the baseline force. Accordingly, as shown in FIG. 27A, although thebreakaway force F_(break_1) is equal in magnitude in every direction,the amount of additional force required in addition to baseline holdforce F_(hold_base) in the direction of baseline hold forceF_(hold_base) to achieve breakaway force F_(break_1) is reduced by themagnitude of baseline hold force F_(hold_base) along the direction ofbaseline hold force F_(hold_base).

As shown in FIG. 27B, by establishing breakaway force F_(break_2) basedon baseline hold force F_(hold_base), the same amount of force will berequired to be applied to the distal end of the robot arm to achievebreakaway force F_(break_2) in every direction when the instrument is inthe desired static position. For example, although the total amount offorce applied to the distal end of the robot arm in the direction ofbaseline hold force F_(hold_base) to achieve breakaway force F_(break_2)in that direction is the sum of baseline hold force F_(hold_base) andbreakaway force F_(break_2), the amount of additional force required by,e.g., a user, to be applied to the robot arm is only breakaway forceF_(break_2), as the system is already applying baseline hold forceF_(hold_base) to the robot arm.

As described above, the systems described herein may detect the angularoffset between a camera head of a laparoscope and the distal end of therobot arm coupled to the laparoscope. For example, FIG. 28A illustratesconventional laparoscopic device 10 having camera sensor module 11,which may be removeably coupled to and rotatable relative to laparoscopedevice 10, e.g., at the proximal end of laparoscope device 10. During asurgical laparoscopic procedure, camera sensor module 11 may be attachedto laparoscope device 10 to allow the user to modify the orientation ofcamera sensor module 11 intraoperatively. As shown in FIG. 28B, duringoperation when laparoscope device 10 is removeably coupled to distallink 316 of the robot arm via coupler body 500, camera sensor module 11may be rotated relative to laparoscope device 10, and accordingly, thedistal end of the robot arm, either intentionally or inadvertently, suchthat the orientation of camera sensor module 11 would change relative tothe distal end of the robot arm, e.g., where laparoscope device 10 iscoupled to the robot arm, resulting in an angular offset between camerasensor module 11 and the distal end of the robot arm.

Referring now to FIG. 29 , an exemplary framework for detecting anddetermining an angular/rotation offset between camera sensor module 11and the distal end of the robot arm is provided. As shown in FIG. 29 ,computational framework 2900 may comprise two main steps: image motioncalculation, e.g., image motion computation 2902 and image motiondirection computation 2904, and image-to-robot synchronization, e.g.,robot pivoting motion execution 2906 and synchronization 2908 in aforeground mode and/or robot pivoting motion identification 2912 andsynchronization 2914 in a background mode, such that the angular offsetmay be determined by orientation offset computation 2910.

Image motion calculation may be used to quantify image motion, e.g., thechanges across consecutive images acquired from the laparoscopic cameraresulting from movement of the laparoscope during operation, e.g.,during the robotic instrument centering mode. For example, to quantifyimage motion for image registration, the motion of individual pixels ofthe laparoscopic images between consecutive images may be computed atimage motion computation 2902, and the motion results may then becombined to obtain the image motion direction on the image space atimage motion direction 2904.

At image motion computation 2902, a plurality of 2D images may bereceived from the laparoscope device, and a computer vision techniquesuch as, for example, optical flow, may be used to compute the motion ofindividual pixels of the laparoscopic images between consecutive images,which provides displacements of each individual pixel betweenconsecutive images in the x and y directions within the 2D plane of theimages. With the x and y displacements of the individual pixels betweenconsecutive images, at image motion direction 2904, the averages, e.g.,means/median, of both the x and y displacements may be calculated toobtain the motion vector in the 2D image space, to thereby calculate theimage motion direction. For example, the image motion direction (inangle) may be calculated as:

$\tan^{- 1}\frac{y_{mean}}{x_{mean}}$

FIG. 30A illustrates the motion vector of each individual pixel betweenthe current image and the previous image, and image motion directionvector 3000, calculated based on the averages of the x and ydisplacements of the individual pixels between consecutive images. FIG.30B illustrates image motion direction vector 3000 across consecutiveimages over time, calculated in real-time as the laparoscope movesduring operation, e.g., by averaging the image motion directionscomputed over time. Moreover, the image motion direction (in angle)further may be validated to confirm that the computed angle may betrusted, e.g., by analyzing metrics such as motion magnitude,percentage, and consensus. For example, the norm of the motion vectormay be calculated to determine the motion magnitude, which may beindicative of whether the computed image motion is significant or not.Accordingly, in some embodiments, the motion magnitude may be comparedagainst a predetermined motion magnitude threshold, such that the motionmagnitude is determined to be significant if it is greater than thepredetermined motion magnitude threshold. The norm of the motion vectormay be calculated as:

√{square root over (x _(mean) ² +y _(mean) ²)}

Moreover, motion percentage may be calculated as the percentage of imagepixels that moved between consecutive images, which may be indicative ofwhether the motion is global motion introduced by movement of thelaparoscope device, or local motions caused by, e.g., tissue-toolinteraction. In addition, the percentage of moved pixels that agree onthe computed image motion direction may be counted to calculate motionconsensus. The agreement may be checked by calculating the relativeangle between the motion vector of each individual pixel betweenconsecutive images and the image motion direction vector. For example,the relative angle may be calculated as:

$\cos^{- 1}\left( \frac{{x_{ind}*x_{mean}} + {y_{ind}*y_{mean}}}{\sqrt{\sqrt{x_{ind}^{2} + y_{ind}^{2}}}*\sqrt{x_{mean}^{2} + y_{mean}^{2}}} \right)$

The relative angle may be compared against a predetermined relativeangle threshold, such that the individual pixel motion vector isdetermined to agree with the computed image motion vector is therelative angle is greater than the predetermined relative anglethreshold. Accordingly, based on the validation metrics above, thepixels in the black boarders and the pixels indicating local tissuemotion may be filtered from the optical flow displayed in FIG. 30A.

Image-to-robot synchronization may be used to differentiate the imagemotion caused by the movement of the laparoscope device from the imagemotion caused by local tissue/instrument movement. For example, themotion of the laparoscope device, e.g., the motion of the distal end ofthe robot arm, may be retrieved from the robot arm sensors, e.g.,encoders, during operation. Moreover, the corresponding motions of theimage and the laparoscope device may be synchronized based on theavailable timestamps of robot arm motion and the laparoscopic images. Asshown in FIG. 29 , image-to-robot synchronization may be implemented ina foreground mode where the system causes the robot arm coupled to thelaparoscope device to move in a predefined pattern of motion to providethe image motion, and/or a background mode where the image motion isgenerated as the laparoscope device is moved by the user during anoperation, e.g., for surveying and/or view angle adjustment.

As shown in FIG. 29 , in foreground mode, at robot pivoting motionexecution 2906, the system may cause the robot arm to move thelaparoscope along a predetermined pivoting trajectory, as shown in FIG.31 . As shown in FIG. 31 , laparoscope device 10 may be moved in/out,and/or pivoted about trocar Tr. Referring again to FIG. 29 , atsynchronization 2908, based on the timestamps of when the predeterminedpivoting trajectory is executed, corresponding timestamps of thecomputed image motion may be extracted. Accordingly, at orientationoffset comparison 2910, a comparison between the robot arm motion andthe computed image motion may be performed to calculate the angularoffset between the orientation of the camera sensor module and thedistal end of the robot arm, e.g., by calculate the angle between thecomputed image motion direction vector and the retrieved robot armmotion vector.

In background mode, at robot pivoting motion identification 2912,movement of the distal end of the robot arm, e.g., passive robot armmotion, responsive to movement of the laparoscope device by the user maybe retrieved from the robot arm sensors. At synchronization 2914, basedon the timestamps of the retrieved robot arm movements, correspondingtimestamps of the computed image motion may be extracted. Accordingly,at orientation offset comparison 2910, a comparison between the robotarm motion and the computed image motion may be performed to calculatethe angular offset between the orientation of the camera sensor moduleand the distal end of the robot arm, e.g., by calculate the anglebetween the computed image motion direction vector and the retrievedrobot arm motion vector.

Moreover, manual rotation of the camera sensor module relative to thelaparoscope device by the user during operation may be detected inreal-time. For example, when the robot arm is stationary while thecamera sensor module is being rotated by the user, the motion of eachindividual pixel of the images may be computed between consecutiveimages responsive to the rotation, and aggregated in the angle space toobtain the rotation change. The computer vision techniques describedherein further may be used to identify the laparoscope device type,e.g., whether the laparoscope device is has a flat tip or an angled tip.For example, the system may cause the robot arm to move the laparoscopedevice back/forth along the longitudinal axis of the laparoscope device.Accordingly, based on the validation metrics described above, if thecomputed image motion direction is greater than a predeterminedthreshold indicating a major direction on the image space, the systemmay determine that the laparoscope device is not a flat tip laparoscopedevice. In contrast, if the computed image motion direction is less thanthe predetermined threshold indicating a minor direction on the imagespace, e.g., zoom in/out, the system may determine that the laparoscopedevice is a flat tip laparoscope device.

Referring again to FIG. 18 , at step 1814, when the laparoscopicprocedure is complete, the operator may remove the surgical instrumentsfrom the respective robot arms.

Referring now to FIG. 32 , a high level example 2400 of the differentcombinations of data inputs for the various sensors and devices of thesystems disclosed herein, e.g., system 100, and the multiple featuresand capabilities that any implementations of the systems disclosedherein may have and can produce based at least in part on the multiplepossible data inputs is provided. As shown in FIG. 32 , someimplementations of the system may be configured to gather data from atleast three monitoring sources 2402, including telemetry from the system(which may include force data from the robot arms, position data fromthe robot arms, etc.), data from proximity sensors 212, and/or depthdata from optical scanner 202. The data gathered from the monitoringsources 2402 may undergo data processing steps 2404 using one or moreprocessors in the system. The data processing steps may include, e.g.,data fusion (e.g., fusion of the data gathered from the monitoringsources 2402) and data analysis, which may include algorithmcomputations. In addition, the data from the monitoring sources 2402 mayundergo processing 2404 for the development of system usability features2406, system safety features 2408, and system performance features 2410.The system may provide the features in real-time. For example, thesystem usability features may include identifying the surgeon andadjusting the platform height based on the surgeon's profile, detectingthe skin surface of the patient and creating a virtual boundary aroundthe skin surface to prevent inadvertent contact with the skin surface ofthe patient, detecting an instrument type and automatically loading thecalibration file appropriate for the particular instrument, etc. Inaddition, the system safety features may include displaying a virtualmap of the area surrounding platform 200, as shown in FIG. 33 , e.g., asan operator moves platform 200 throughout the operating room, to providethe operator with a view of the area surrounding platform 200, such thatthe operator may avoid collisions between platform 200 and any objectsand/or persons within the area surrounding platform 200.

As shown in FIG. 33 , the depth data generated by the plurality ofoptical sensors may be used by the controller of system 100 to generatea virtual map, e.g., a “bird's eye view”, of the area surroundingplatform 200, e.g., within the operating room, in real-time. Forexample, the virtual map may illustrate the operating room from a topperspective. Moreover, as shown in FIG. 33 , the virtual map may includegraphical representations of platform 200 (including robot arms 300 a,300 b), as well as one or more objects, e.g., patient table PT, and/orone or more persons, e.g., operator O, person P1, and person P2, withinthe area surrounding platform 200 in the same co-ordinate space as theplatform and robot arms. Specifically, the virtual map may graphicallyillustrate the proximity between platform 200 and the one or moreobjects/persons, e.g., as platform 200 is being moved through theoperating room by operator O. The controller may cause display 210 todisplay the virtual map, such that operator O can view the virtual mapon display 210 in real-time as operator O moves platform 200 through theoperating room. Accordingly, operator O may see objects and/or personsin the area surrounding platform 200 that operator O could not otherwisesee with their own eyes, e.g., due to platform 200 and/or robot arms 300a, 300 b obstructing the view of operator O, and avoid collisionsbetween platform 200 and/or robot arms 300 a, 300 b with theobjects/persons in the operating room. Moreover, the controller maycause display 210 to display an alert, e.g., a visual or audible alert,when the virtual map indicates that platform 200 and/or robot arms 300a, 300 b are approaching or within a predetermined distance from the oneor more objects/persons within the operating room.

In some embodiments, the controller may only cause display 210 todisplay the virtual map while platform 200 is being moved within theoperating room. For example, platform 200 may include one or moreactuators, e.g., a button, lever, or handlebar, that may be operativelycoupled to the braking mechanism of the wheels of platform 200, suchthat upon actuation of the actuator, the braking mechanism is disengagedsuch that mobility of platform 200 is permitted. Accordingly, when theactuator is not actuated, the braking mechanism is engaged such thatmobility of platform 200 is prevented. Thus, upon actuation of theactuator, the controller may automatically cause display 210 to displaythe virtual map, such that operator O can view the area surroundingplatform 200 before, during, or after movement of platform 200 while thebraking mechanism is disengaged. Once the actuator is released, suchthat the braking mechanism is reengaged, display 210 may stop displayingthe virtual map. In some embodiments, when the virtual map indicatesthat platform 200 and/or robot arms 300 a, 300 b are approaching orwithin the predetermined distance from the one or more objects/personswithin the operating room, the controller may override actuation of theactuator by the operator and reengage the braking mechanism to therebyprevent further movement of platform 200. Accordingly, the actuator mayneed to be released and re-actuated by the operator to disengage thebraking mechanism and permit further movement of platform 200.

Moreover, the system may process color and/or depth data obtained fromoptical scanners 202 and proximity sensors 212 to identify objectswithin the operating room, e.g., the patient bed or the trocar, as wellas the planes associated with the identified objects. With knowledge ofthe location platform 200 and robot arms 300 a, 300 b relative to theidentified objects, the system may cause the stages coupled to the baseportions of robot arms 300 a, 300 b to automatically move (or stopmovement of) robot arms 300 a, 300 b to avoid collision with theidentified objects during setup, e.g., when robot arms 300 a, 300 bapproaches a predetermined distance threshold relative to the identifiedobjects. In addition, the system may generate and emit, e.g., an audiblealert indicative of the proximity of the stages of platform 200 and/orrobot arms 300 a, 300 b relative to the identified objects. For example,the audible alert may change in amplitude and/or frequency as thedistance between the stages of platform 200 and/or robot arms 300 a, 300b and the identified objects decreases, as perceived by the system basedon the depth data.

In addition, with knowledge of the location platform 200 and robot arms300 a, 300 b relative to the trocar, if the system detects that theposition of the patient bed, and accordingly the trocar, is changing,e.g., via adjustment by a user, the system may automatically adjust thearrangement of the robot arm to accommodate the movement of the patientbed and maintain relative position between the distal end of the robotarm and the trocar. In some embodiments, upon detection of movement ofthe patient bed, the system may automatically move the robot arm toretract the surgical instrument coupled thereto within the trocar, priorto automatically adjusting the arrangement of the robot arm to maintainrelative position between the distal end of the robot arm and thetrocar, such that the distal end of the surgical instrument ispositioned within the trocar and away from anatomical structures withinthe patient.

Referring to FIG. 34 , a schematic overview of the electrical componentsof the electrical system and connectivity 2600 of the system isprovided. This includes the flow of energy throughout the illustratedportion of the system. As shown in FIG. 34 , all of the electricalcomponents may be powered via an electrical connection with aconventional electrical power source, e.g., plugging the system into aconventional power outlet. For example, each of the stages of platform200, e.g., vertical extenders 206 a, 206 b and horizontal extenders 208a, 208 b, for adjusting the horizontal and vertical position of robotarms 300 a, 300 b relative to platform 200 (actuators 1-4), and each ofthe motors, e.g., M1-M4, of each robot arm for applying impedance and/oractuating the respective robot arms (arms 1-2), may be controlled viarespective actuator controllers and arm controllers 1-2, which arepowered by the electrical connection via an AC/DC power supply.Moreover, the computing components of each robot arm (computing units1-2) also may be powered by the electrical connection when the system isplugged in. As shown in FIG. 34 , the system may include anuninterruptable power supply (UPS) that may be charged while the systemis plugged in via an isolation transformer, and which is operativelycoupled to computing units 1-2, such that the UPS battery mayautomatically provide power to computing units 1-2 when the system istemporarily unplugged from the electrical power source, e.g., to movethe system to another side of a patient table during a multi-quadrantprocedure. Accordingly, computing units 1-2 may remain online, and willnot need to be restarted, when the system is re-plugged, such thatcomputing units 1-2 are ready to operate once power is restored to therest of the system, thereby saving valuable time in the operating room.In some embodiments, the braking mechanism of wheels 204 of platform 200also may be operatively coupled to the UPS battery, such that they maybe engaged/disengaged while the system is unplugged and moved around theoperating room.

Referring now to FIG. 35 a flow chart of process 3500 for theacquisition and processing of data from an optical scanning device isprovided. As shown in FIG. 35 , at step 3502, depth data may be acquiredfrom one or more optical scanning devices, e.g., optical scanner 202and/or proximity sensors 212. At step 3504, filtering/other signalprocessing algorithms may be performed, e.g., median filter, Gaussiannoise removal, anti-aliasing algorithms, morphological operations,ambient light adjustments, etc. At step 3506, 3D object segmentation maybe performed using, e.g., template matching, machine learning, Bruteforce matching, color plus depth segmentation, object segmentation,2D-3D registration, pixel value thresholding, etc. At step 3508, objectcoordinates may be transformed to task space. For example, transformingobject coordinates to task space may include converting a position andan orientation of an object from the optical scanning device'scoordinate frame to the coordinate frame of the task needed (e.g., arobot frame for robot control, a cart frame for system setup, etc.).Additionally or alternatively, transforming object coordinates to taskspace may include using known optical scanning device to the supportplatform (e.g., a cart) transformations, the surgical robottransformations, and/or the user interface screen transformations, andgenerating new transformations for specific tasks such as tracking thesurgeon's body (e.g., face, hands, etc.) with respect to differentelements of the system (e.g., support platform, robot arms, screen,etc.), tracking the surgical table with respect to the cart platform,tracking patient orientation for system setup, tracking trocar portlocation and orientation for setup, and tracking the position ofoperating room staff for safety. At step 3510, the desired task may beperformed, e.g., moving the robot arms into the vicinity of thepatient/trocar port for easy setup, tracking operating room staff toensure the system only responds to surgeon commands, recording thesurgeon's hand movements during different phases of surgery, tracking asurgical instrument within a field of view of the laparoscope, etc.

In addition, FIG. 35 illustrates a flow chart of process 3520 for theacquisition and processing of data from an optical scanning device toidentify a trocar port for setting up the robot arm for a procedure. Atstep 3522, depth data may be acquired from one or more optical scanningdevices, e.g., optical scanner 202. At step 3524, specular noisefiltering may be performed. At step 3526, patient/trocar portsegmentation and identification may be performed. At step 3528, trackedport coordinates may be transformed to robot coordinate space. At step3530, the robot arms may be moved to a desired vicinity of thepatient/trocar port. Moreover, FIG. 35 illustrates a flow chart ofprocess 3540 for the acquisition and processing of data from an opticalscanning device for identifying a surgical instrument for tracking toprovide instrument centering. At step 3542, depth data may be acquiredfrom one or more optical scanning devices, e.g., a laparoscope coupledto the robot arm. At step 3544, specular noise filtering may beperformed. At step 3546, surgical instrument segmentation andidentification may be performed to distinguish the surgical instrumentto be tracked from other objects within the field of view of thelaparoscope. At step 3548, tracked surgical instrument coordinates maybe transformed to robot coordinate space. At step 3550, the robot armholding the laparoscope may be moved to thereby move the laparoscope tomaintain the tracked surgical instrument within the field of view of thelaparoscope.

Referring now to FIG. 36 an example data flow 3600 of the system isprovided. As shown in FIG. 36 , non-real-time computer 3602 may gatherdata from an optical scanning device, e.g., optical scanner 202 and/orfrom a camera feed from a laparoscope. Non-real-time computer 3602 alsomay receive data from real-time computer 3608 having a robot controller,including telemetry information such as positions of the robot arms,forces applied to the various motors/sensors of the robot arms,operational mode information, etc. Non-real-time computer 3602 also mayreceive data from patient database 3610 having information specific tothe patient in the procedure including, e.g., CT scan data, relevanthealth conditions, and other information that may be desired by thesurgeon, and further may receive data from online database 3611 fortraining/updating a trajectory generation model. For example, the onlinedatabase further may include a hospital medical record database, suchthat the system may access the procedure type and any other medical dataavailable (e.g., CT scan images, x-ray images, MRI images, and/or otherpatient specific information), which may be used to inform positioningof the trocar ports, and the position and orientation of platform 200relative to the patient.

Non-real-time computer 3602 further may provide user feedback 3612 tothe user via user interface 3614. User feedback may include, e.g.,collision notifications, positioning information and/or recommendationsregarding the various components of the system, the operational modethat has been detected by the system, etc. Non-real-time computer 3602further may provide commands 3618, e.g., high level commands, toreal-time computer 3608. High-level commands may include, e.g., modechanges, trajectories, haptic barriers, user configurations, etc.Real-time computer 3608 may include robot controller 3620 programmed toprovide robot commands 3622, e.g., motion or force commands, to the oneor more robot arms 3624, e.g., robot arms 300. Robot controller 3620 mayreceive robot feedback data 3626, e.g., motion, force, and/or touchpointdata, etc., from the one or more robotic arms 3624.

FIG. 37 illustrates data flow 3700 for updating the systemconfigurations based on learned behaviors of the user. As shown in FIG.37 , the system may be connected to an online database that may store asurgeon profile and each of a plurality of possible data sources, whichmay include optical sensors, encoders, and/or other sensors, and/or adatabase of manually entered user input. The data sources may beassociated with a given surgeon, their preferred robot arm arrangementand operating parameters, and each procedure performed with the system,which may allow the recording and analysis of the system configurationand how it changes from procedure to procedure, and within theprocedure. In the case of machine learning, the co-manipulationcapability of the system may be leveraged such that the user's actionsmay be used to annotate the data to create a training dataset. Forexample, the trajectory generation module may be trained with therecorded trajectories of a given surgeon using the instrument centeringmode in a previous procedure and updated to enhance that surgeon'sexperience in a subsequent procedure, as well as other surgeons usingthe instrument centering mode.

Referring now to FIG. 38 , dataflow 3800 of a distributed network ofco-manipulation surgical robot systems is provided. For example, adistributed network of co-manipulation robotic (“cobot”) surgicalsystems may be used in multiple hospitals, each of which may beconnected to an online database. This arrangement may provideconsiderably more data and user information that may be used by any ofthe cobot systems in operation. The systems may aggregate the data fromthe distributed network of systems to identify the optimumconfiguration/trajectories based on factors such as procedure type,surgeon experience, patient attributes etc. Through analytics orclinician input, the cobot systems may identify a routine procedureversus a procedure that may be more complicated. This information may beused to provide advice or guidance to novice surgeons.

Moreover, centralizing procedure data may enable the running of largedata analytics on a wide range of clinical procedures coming fromdifferent users. Analysis of data may result in optimized settings for aspecific procedure, including, e.g., optimized system positioning,optimal ports placement, optimal algorithms settings for each robot armand/or detection of procedure abnormalities (e.g., excessive force,time, bleeding, etc.). These optimal settings or parameters may dependon patient and tool characteristics. As described above, a surgeon mayload and use optimal settings from another surgeon or group of surgeons.This way, an optimal setup may be achieved depending on, e.g., thesurgeon's level of expertise. To keep track of the various users in thedistributed network of cobot systems, it may be beneficial to identifyeach user. As such, the user may log into the cobot system and accesstheir profile online as necessary. This way the user may have access totheir profile anywhere and will be able to perform a clinical procedurewith their settings at a different hospital location.

An example user profile may contain the user's specific settings andinformation, including, e.g., username; level of expertise; differentprocedures performed, and/or region of clinical practice. In addition,the clinical procedure may require a user to store specific settingssuch as clinical procedure (e.g., cholecystectomy, hernia, etc.), tableorientation and height, preferred port placement, settings per assistantarm for each algorithm, patient characteristics (e.g., BMI, age, sex),and/or surgical tools characteristics and specifications (e.g., weights,length, center of gravity, etc.). The user may be able to enable his ownprofile, and optionally may enable another user's profile, such as theprofile of a peer, the most representative profile of a surgeon of theuser's area of practice, the most representative profile of a surgeonwith a specific level of expertise, and/or the recommended profileaccording to patient characteristics.

The identification of a user may be performed via password, RFID key,facial recognition, etc. Learning from a large number of procedures mayresult in a greater level of optimization of the cobot system setup fora given procedure. This may include, e.g., cart position, individualrobot arm position, surgical table height and orientation, portplacement, setup joints position, laparoscope trajectories duringinstrument centering. These settings may be based on patient height,weight, and sex, and further may be interdependent. For example, theoptimal port placement may depend on patient table orientation.

Additionally, a clinical procedure may be described as a sequence ofclinical procedures steps. Learning these different steps may allow thecobot system to infer in real time the actual step for a givenprocedure. For example, learning clinical steps from procedures mayallow or enable: adjustment of algorithm settings, adjustment of robotarm configuration to facilitate user action in a given phase, adjustmentof a laparoscope position based on the phase of the procedure, thesystem to give the practical custom reminders, the system to notifystaff of an estimate procedure end time, the system to alert staff ifnecessary equipment is not available in the room, and/or the system toalert staff of the occurrence of an emergency situation.

During a clinical procedure, the surgeon will often realize simple androutine surgical tasks such as grasping, retracting, cutting etc.Learning these different tasks may allow the cobot system to infer inreal time preferences and habits of the surgeon regarding a sequence ofa procedure in real time. Some algorithms of the cobot system may betuned (i.e., adjusted and optimized) during the procedure based on thissequence recognition and help the user to be better at this simplesurgical task. An example of such a task is the automated retraction ofa liver during a gall bladder procedure. By aggregating the informationover many cases, the optimized force vectors may be developed.

Further, some complications may occur during a clinical procedure thatmay result in unexpected steps or surgical acts. Learning how todiscriminate these unexpected events would help the cobot system toenable some specific safety features. In case of emergency, the robotarms may be stopped or motion restricted depending on the level ofemergency detected by the system.

Referring now to FIGS. 39A to 39R, screenshots of an exemplary graphicaluser interface are provided. The graphical user interface may beconfigurable by a user and may be integrated with display 210. As shownin FIG. 39A, during an initial setup, the user may select a specificsurgeon and/or specific surgical procedure, e.g., from a pre-loaded dropdown list of surgeons and/or procedures. In this manner, the user mayselect from a plurality of predetermined, selectable surgicalprocedures, which will permit the system to automatically position therobot arms in the optimal configuration to start that specific surgicalprocedure. For example, as shown in FIGS. 39A and 39B, a cholecystectomyprocedure is a selectable option, although other selectable proceduresare available as described below. Moreover, the user may select whetherto turn on/off the audio and/or tactile feedback features of the system.As shown in FIG. 39B, the user may select between and configure variouspreset configurations of the system, e.g., platform 200 and robot arms300 a, 300 b, which may be specific to which side of the patient tablethe system is positioned as well as the location of the trocar port(s),and further may depend on which quadrant of the patient body thesurgical procedure will take place on and/or the anticipatedconfiguration of the surgical bed. As shown in FIG. 39C, the user mayselect to turn on/off features such as high force mode, and/or advancedfeatures such as instrument centering mode.

As shown in FIG. 39D, the user may reconfigure the position of the robotarms by rotating the shoulder link of the robot arms about Q3 asdescribed above, as well as by adjusting the stages of the platform toadjust the vertical/horizontal position of the robot arms relative tothe platform via GUI 210. For example, the user may toggle, e.g., slide,first digital actuator 3902 on display 210, e.g., left and right,relative to a neutral position (e.g., a center position on display 210)to cause rotation of the distal shoulder link of the robot arm relativeto the proximal shoulder link of the robot arm. In addition, display 210may display indicator 3904 alongside graphical representations 3906 ofthe robot arm in different angular configurations to inform the user ofthe current configuration of the robot arm in real-time. For example,the position of indicator 3904 relative to graphical representations3906 may be moved responsive to actual rotation of the shoulder link ofthe robot arm via actuation of first digital actuator 3902. Firstdigital actuator 3902 may automatically return to the neutral positionupon release of first digital actuator 3902 by the user; whereas,indicator 3904 may remain in position relative to graphicalrepresentations 3906 to accurately indicate the degree of rotation andconfiguration of the shoulder link of the robot arm. In someembodiments, the distance of first digital actuator 3902 from theneutral position, as actuated by the user, may determine the velocity ofrotation of the shoulder link. For example, by moving first digitalactuator 3902 only a short distance from the neutral position, thedistal shoulder link of the robot arm may be rotated relative to theproximal shoulder link of the robot arm in a corresponding direction ata first velocity, and by moving first digital actuator 3902 a largerdistance from the neutral position, the distal shoulder link of therobot arm may be rotated relative to the proximal shoulder link of therobot arm in a corresponding direction at a second velocity greater thanthe first velocity. Rotation of the distal shoulder link relative to theproximal shoulder link in the corresponding direction may slow down asthe distal shoulder link approaches its maximum range of rotationrelative to the proximal shoulder link until reaching a complete stop.

Similarly, as shown in FIG. 39D, the user may toggle, slide, seconddigital actuator 3908 on display 210, e.g., left, right, up, down,and/or diagonally, within cursor pad 3910 to cause correspondinghorizontal and/or vertical movement of the stages of the robot armrelative to the platform. In addition, display 210 may display one ormore indicators, e.g., vertical indicator 3912 a and horizontalindicator 3912 b, to inform the user of the current vertical andhorizontal configuration of stages of the robot arm in real-time. Forexample, the position of indicator 3912 a, e.g., relative to cursor pad3910, may be moved responsive to actual vertical movement of the robotarm via actuation of second digital actuator 3908, and the position ofindicator 3912 b, e.g., relative to cursor pad 3910, may be movedresponsive to actual horizontal movement of the robot arm via actuationof second digital actuator 3908. Second digital actuator 3908 mayautomatically return to a neutral position (e.g., a center position oncursor pad 3910) upon release of second digital actuator 3908 by theuser; whereas, indicators 3912 a, 3912 b may remain in respectivepositions relative to cursor pad 3910 to accurately indicate thevertical and horizontal configuration of the robot arm relative to theplatform. In some embodiments, the distance of second digital actuator3908 from the center point of cursor pad 3910, as actuated by the user,may determine the velocity of movement of the stages relative to theplatform. For example, by moving second digital actuator 3908 only ashort distance from the center point of cursor pad 3910, the stage willmove in the base of the robot arm in a corresponding direction at afirst velocity, and by moving second digital actuator 3908 a largerdistance from the center point of cursor pad 3910, the stage will movein the base of the robot arm in the corresponding direction at a secondvelocity greater than the first velocity. Movement of the base of therobot arm via the stage assembly in the corresponding direction may slowdown as the stage assembly approaches its maximum range of extensionrelative to the platform until reaching a complete stop. As describedherein, if the distal end of the robot arm is coupled to a surgicalinstrument, e.g., positioned through a trocar, movement of the base ofthe robot arm via the stage assembly via user input at the graphicaluser interface may further automatically cause movement of the robot armvia one or more of the motorized joints of the robot arm so as tomaintain a static position of the surgical instrument during movement ofthe stages. Moreover, the system may generate an alert when the stageassembly and/or robot arm reaches or nears its respective maximumextension limit.

As shown in FIG. 39E, when the surgeon and/or surgical procedure hasbeen selected, the user may actuate a “drape” mode, such that systemmoves the stages of the platform the robot arms to a preset drapeconfiguration, as shown in FIGS. 39F and 39G, to provide ample space forthe user to drape the robot arms and the platform, as described above.As shown in FIG. 39H, once the system has been properly draped, the usermay actuate a “compact” mode, such that the system moves the stages ofthe platform and the robot arms to a preset configuration that willallow the user to easily move the platform, e.g., toward thepatient/surgical bed, with minimal potential of collision with otherobjects in the operating room. As shown in FIG. 39I, the user mayactuate the system to configure the platform and the robot arms for theselected surgical procedure. As shown in FIGS. 39H-39N, the graphicaluser interface may display step-by-step instructions with accompanyinggraphical illustrations to guide the user in configuring the system tobegin the surgical procedure. For example, the graphical user interfacemay guide the movement of the platform relative to the surgical bed, asshown in FIGS. 39I and 39J and FIGS. 39M and 39N. Moreover, thegraphical user interface may display visual markers to guide positioningof the platform and/or robot arms relative to the surgical bed, e.g.,boundary lines, which may illuminate in different colors upon properplacement of the platform and/or robot arms relative to the boundarylines, and accordingly, the surgical bed. As described in further detailbelow with regard to FIGS. 40A-40C, while the platform is movingrelative to the surgical bed, the graphical user interface may display avirtual map depicting graphical representations of the platform androbot arms and the surgical bed relative to one another.

Additionally, as shown in FIGS. 39J, the graphical user interface maypermit the user to select a surgical procedure, e.g., a cholecystectomy,such that, upon selection by the user, the system causes the platformand/or robot arms to automatically move, e.g., relative to the surgicalbed, to a preset configuration optimized for performing the surgicalprocedure, as shown in FIG. 39K. Although only the cholecystectomysurgical procedure selection is shown in FIG. 39J, as will be understoodby a person having ordinary skill in the art the graphical userinterface may display a plurality of surgical procedure selections forthe user to choose from. For example, the surgical procedures furthermay include, e.g., gastric sleeve, hiatal hernia repair, Nissenfundoplication, inguinal hernia repair (TEP), right, left, and/orcomplete colectomy, gastric bypass, sigmoid colectomy, umbilical herniarepair, incisional hernia repair, etc. Accordingly, the presetconfiguration for each surgical procedure, and in some embodimentsdepending on the surgical procedure, the preset configuration for aphase of a given surgical procedure, may be selected and stored prior tooperation. The preset configuration for a given surgical procedure maybe specific to which side of the patient table the system is positioned,the location of the trocar port(s), which quadrant of the patient bodythe surgical procedure will take place on, and/or the anticipatedconfiguration of the surgical bed. For example, the quadrant of thepatient body and the anticipated surgical bed configuration may drivethe preset configurations as they both dictate in which direction, e.g.,up or down relative to the horizontal plane, a laparoscope may need tobe pointed for a given surgical procedure. Moreover, one or more presetconfigurations may be user specific based on user preference for a givensurgical procedure, and may be stored in the user's profile.

The system may cause the platform and/or robot arms to move to eachpreset configuration by causing movement of the platform and/or robotarms in a limited number of degrees of freedom. For example, as shown inFIG. 41 , the shoulder portion of each robot arm, 300 a, 300 b may berotated about the respective Q3 axis, e.g., in a left or right directionfrom a neutral configuration, and each of base 302 a, 302 b may be movedvia the stages of the platform, e.g., in/out along the horizontal planeand up/down along the vertical plane. Accordingly, based on the limiteddegrees of freedom of movement of the shoulder portions of the robot armand stages of the platform, the system may cause the platform and/orrobot arms to move to any one of a plurality of preset configurationsbased on the selected surgical procedure. For example, Table 1 belowillustrates exemplary movements/configurations of the stage and/or theshoulder portion for each of the robot arms, e.g., ARM 1 and ARM 2 ofFIG. 41 .

TABLE 1 Surgical ARM 1 ARM 2 Procedure Stage Shoulder Stage ShoulderCholecystectomy Down, Out Left Up, In Neutral (upper right quadrant)Gastric Sleeve Down, In Neutral Up, In Right (midline to upper leftquadrant) Left Colectomy Up, Out Right Up, Out Left (lower leftquadrant)

For example, in the case of the laparoscopic cholecystectomy in theupper right quadrant of the patient's body, Arm 1 may hold a laparoscopeand Arm 2 may hold a grasper, the surgical bed angle may be steepreverse Trendelenberg (head up), and the system may be positioned on theright side of the patient. Moreover, the grasper held by Arm 2 will beused to push tissue superiorly (in the direction of the patient's rightshoulder), and the laparoscope would be best positioned at theumbilicus, also pointing superiorly in the direction of the patient'sright shoulder. Thus, to optimize the surgeon's workspace for acholecystectomy surgical procedure, as shown in Table 1, the presetconfiguration is such that the Arm 1 stages are down and out, and theArm 1 shoulder is rotated to the left about the Q3 axis; whereas, theArm 2 stages are up and in, and the Arm 2 shoulder is in the neutralconfiguration. Accordingly, the surgeon may hold active instrumentsbetween the arms, with Arm 1 reaching underneath the surgeon's arms.

Moreover, in the case of a laparoscopic gastric sleeve from the midlineto the upper left quadrant of the patient's body, Arm 1 may hold alaparoscope and Arm 2 may hold a grasper, the surgical bed angle may besteep reverse Trendelenberg (head up), and the system may be positionedon the right side of the patient. However, because the area of theoperation is larger, e.g., from the midline to upper left quadrant, andthe procedure involves retracting tissue inferiorly (towards thepatient's feet), to optimize the surgeon's workspace for a gastricsleeve surgical procedure, as shown in Table 1, the preset configurationis such that the Arm 1 stages are down and in, and the Arm 1 shoulder isin the neutral configuration; whereas, the Arm 2 stages are up and in,and the Arm 2 shoulder is rotated to the right about the Q3 axis.Accordingly, the surgeon may hold active instruments and reachunderneath Arm 2, with more space to retract towards the feet. Inaddition, in the case of a laparoscopic left colectomy in the upper andlower left quadrants of the patient's body, the surgical bed angle maybe Trendelenberg tilt right, and the system may be positioned on theleft side of the patient. Thus, to optimize the surgeon's workspace fora left colectomy surgical procedure, as shown in Table 1, the presetconfiguration is such that the Arm 1 stages are up and out, and the Arm1 shoulder is rotated to the right about the Q3 axis; whereas, the Arm 2stages are up and out, and the Arm 2 shoulder is rotated to the leftabout the Q3 axis. In this manner, the robot arm(s) may be automaticallypositioned in a configuration specific to the selected surgicalprocedure to assist with arm setup for that specific procedure.

Referring now to FIG. 390 , during operation of the system to performthe surgical procedure, the user may select which features to turnon/off at any given phase of the surgical procedure, and/or select toend the procedure. Upon selecting to end the procedure, as shown in FIG.39P, the graphical user interface may display, e.g., a checklist ofactions required to end the procedure, such as detaching all theinstruments from the robot arm, making sure the arms are in aconfiguration away from the patient, and moving the platform away fromthe workspace. As shown in FIG. 39Q, the user may select to shut downthe system and/or start another procedure. FIG. 39R illustrates anexemplary fault alert, such that the user may clear the fault andproceed with the operation once the fault condition has been removed.

Referring now to FIGS. 40A-40C, screenshots of exemplary graphical userinterface displaying a virtual map to guide movement of the platformrelative to a surgical bed are provided. The graphical user interfacemay be configurable by a user and may be integrated with display 210. Asshown in FIG. 40A, when the surgical bed is not within an acceptableproximity of the platform sensors, e.g., optical sensors 202 and/orproximity sensors 212, the graphical user interface may not display thevirtual map depicting graphical representations of the platform androbot arms and the surgical bed, and may display an alert that thedistance to the surgical bed/operation table is undetectable. As shownin FIG. 40B, upon detection of the surgical bed by the platform sensors,e.g., during movement of the platform, the graphical user interface mayautomatically display the virtual map, e.g., a “bird's eye view” of thearea surrounding the platform, depicting the platform and robot armsrelative to the surgical bed. Moreover, the graphical user interface maydisplay information indicative of, e.g., the distance between theplatform (and/or the most extended stage/robot arm) and the surgical bedand the angle of the platform relative to the surgical bed, in real-timeas the platform is moved relative to the surgical bed. When motion ofthe platform has stopped, e.g., when the platform has reached the targetlocation relative to the surgical bed, the graphical user interface maystop displaying the virtual map, as shown in FIG. 40C. Accordingly, thegraphical user interface may display the virtual map only duringmovement of the platform by the user, such that when the platform stopsmoving, the virtual map is no longer displayed. Alternatively, thegraphical user interface may display the virtual map once the surgicalbed is within an acceptable proximity to the platform sensors until theplatform stops moving at the target location relative to the surgicalbed. The graphical user interface further may indicate when the platformis in a locked state where mobility of the platform is prohibited, e.g.,when the user actuates a locking pedal to engage the braking mechanismof the platform.

Some implementations of the systems described herein may be configuredto be controlled or manipulated remotely, e.g., via joystick or othersuitable remote control device, computer vision algorithm, forcemeasuring algorithm, and/or by other means. However, in a preferredembodiment, the systems described herein operate without any telemetry,e.g., the robot arm is not teleoperated via a remote surgeon consoleseparate from the robot arm, but instead the robot arm moves in responseto movement applied to the surgical instrument coupled thereto. Anyrobot-assisted movements applied to the surgical instrument by thesystem, e.g., in the robotic assist mode, are not responsive to userinput received at a remote surgeon console.

While various illustrative embodiments of the invention are describedabove, it will be apparent to one skilled in the art that variouschanges and modifications may be made therein without departing from theinvention. The appended claims are intended to cover all such changesand modifications that fall within the true scope of the invention.

What is claimed:
 1. A co-manipulation surgical system to assist with laparoscopic surgery performed using a surgical instrument having a handle, an operating end, and an elongated shaft therebetween, the co-manipulation surgical system comprising: a robot arm comprising a plurality of links, a plurality of joints comprising one or more motorized joints, a setup joint, and one or more passive joints, a proximal end operatively coupled to a base of the robot arm, and a distal region having a distal end configured to be removably coupled to the surgical instrument; a plurality of motors operatively coupled to the one or more motorized joints and to the setup joint; and an actuator operatively coupled to the setup joint and configured to be actuated to cause rotation of a distal link of the plurality of links adjacent to the setup joint relative to a proximal link of the plurality of links adjacent to the setup joint from a first setup configuration to a second setup configuration responsive to actuation of the actuator, wherein, when the actuator is in an unactuated state, the robot arm is permitted to be freely moveable responsive to movement at the handle of the surgical instrument for performing laparoscopic surgery via the one or more motorized joints and the one or more passive joints while the distal link adjacent to the setup joint and the proximal link adjacent to the setup joint remain in the second setup configuration.
 2. The co-manipulation surgical system of claim 1, wherein the actuator comprises a collar rotatably coupled to a link of the plurality of links, the collar configured to be rotated in a first direction relative to the link of the plurality of links to cause rotation of the distal link adjacent to the setup joint in a corresponding first direction relative to the proximal link adjacent to the setup joint, and rotated in a second direction relative to the link of the plurality of links to cause rotation of the distal link adjacent to the setup joint in a corresponding second direction relative to the proximal link adjacent to the setup joint.
 3. The co-manipulation surgical system of claim 2, wherein the collar comprises a setup mode actuator, the setup mode actuator configured to be actuated to permit the rotation of the distal link adjacent to the setup joint in the corresponding first and second directions relative to the proximal link adjacent to the setup joint responsive to rotation of the collar.
 4. The co-manipulation surgical system of claim 2, wherein the collar is spring-enforced such that upon release of the collar in any position, the collar is configured to return to a neutral position relative to the link of the plurality of links.
 5. The co-manipulation surgical system of claim 1, further comprising: a graphical user interface operatively coupled to the setup joint, wherein the actuator is configured to be displayed on the graphical user interface.
 6. The co-manipulation surgical system of claim 5, wherein the actuator comprises a slidable cursor configured to be moved relative to a neutral center point, and wherein movement of the slidable cursor in a first direction relative to the neutral center point causes rotation of the distal link adjacent to the setup joint in a first direction relative to the proximal link adjacent to the setup joint, and movement of the slidable cursor in a second direction relative to the neutral center point causes rotation of the distal link adjacent to the setup joint in a second direction relative to the proximal link adjacent to the setup joint.
 7. The co-manipulation surgical system of claim 6, wherein the distal link adjacent to the setup joint is configured to rotate in the corresponding direction relative to the proximal link adjacent to the setup joint a velocity that correlates with a distance of the slidable cursor from the neutral center point.
 8. The co-manipulation surgical system of claim 5, wherein the graphical user interface is configured to display an indicator, the indicator indicative of a configuration of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint in real-time responsive to actuation of the actuator.
 9. The co-manipulation surgical system of claim 8, wherein the graphical user interface is configured to display graphical representations of a plurality of configurations of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint, such that a position of the indicator relative to the graphical representations of the plurality of configurations is indicative of the configuration of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint in real-time responsive to actuation of the actuator.
 10. The co-manipulation surgical system of claim 1, further comprising a controller operatively coupled to the robot arm, the controller programmed to cause the robot arm to be freely moveably responsive to movement at the handle of the surgical instrument for performing laparoscopic surgery during an operating stage.
 11. The co-manipulation surgical system of claim 10, wherein the controller is configured to switch from the operating stage to a setup stage upon actuation of a setup mode actuator, and wherein actuation of the actuator only causes rotation of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint when the setup mode actuator is in an actuated state.
 12. The co-manipulation surgical system of claim 1, wherein, when the actuator is in an actuated state, application of a force at the distal region of the robot arm in a first direction causes rotation of the distal link adjacent to the setup joint in a first direction relative to the proximal link adjacent to the setup joint, and application of a force at the distal region of the robot arm in a second direction causes rotation of the distal link adjacent to the setup joint in a second direction relative to the proximal link adjacent to the setup joint.
 13. The co-manipulation surgical system of claim 1, wherein, when the actuator is in the unactuated state, the setup joint is configured to cause the distal and proximal links adjacent to the setup joint to be fixed relative to each other in the second setup configuration.
 14. The co-manipulation surgical system of claim 1, wherein all motors of the plurality of motors operatively coupled to the one or more motorized joints are disposed within the base of the robot arm.
 15. The co-manipulation surgical system of claim 1, wherein a shoulder link of the plurality of links comprises a distal shoulder link rotatably coupled to a proximal shoulder link via the setup joint, and wherein the motor of the plurality of motors operatively coupled to the setup joint is not back-drivable.
 16. The co-manipulation surgical system of claim 15, wherein the motor of the plurality of motors operatively coupled to the setup joint is disposed on the shoulder link adjacent to the setup joint.
 17. The co-manipulation surgical system of claim 1, further comprising a platform operatively coupled to the base of the robot arm, the platform comprising a stage assembly configured to independently move the base of the robot arm in a horizontal direction and in a vertical direction relative to the platform.
 18. The co-manipulation surgical system of claim 17, wherein, in a user guided setup mode, application of a force at the distal region of the robot arm in a first direction causes the stage assembly to move the base of the robot arm in the horizontal direction relative to the platform, and application of a force at the distal region of the robot arm in a second direction causes the stage assembly to move the base of the robot arm in the vertical direction relative to the platform.
 19. The co-manipulation surgical system of claim 18, further comprising: a setup mode actuator configured to be actuated to switch the system to the user guided setup mode, wherein the system remains in the user guided setup mode only while the setup mode actuator is actuated.
 20. The co-manipulation surgical system of claim 19, wherein the actuator comprising a collar rotatably coupled to a link of the plurality of links, wherein the setup mode actuator is disposed on the collar, and wherein actuation of the setup mode actuator permits rotation of the collar in a first direction to cause rotation of the distal link adjacent to the setup joint in a corresponding first direction relative to the proximal link adjacent to the setup joint, and permits rotation of the collar in a second direction to cause rotation of the distal link adjacent to the setup joint in a corresponding second direction relative to the proximal link adjacent to the setup joint.
 21. The co-manipulation surgical system of claim 1, wherein the co-manipulation surgical system is not teleoperated via user input received at a remote surgeon console.
 22. A method for assisting with laparoscopic surgery using a robot arm comprising a plurality of links, a plurality of joints comprising one or more motorized joints, a setup joint, and one or more passive joints, a proximal end operatively coupled to a base of the robot arm, and a distal region having a distal end configured to be removably coupled to a surgical instrument, the method comprising: actuating an actuator operatively coupled to a motor operatively coupled to the setup joint to cause rotation of a distal link of the plurality of links adjacent to the setup joint relative to a proximal link of the plurality of links adjacent to the setup joint from a first setup configuration to a second setup configuration responsive to actuation of the actuator; and moving, when the actuator is in an unactuated state, the robot arm responsive to movement at the handle of the surgical instrument for performing laparoscopic surgery via the one or more motorized joints and the one or more passive joints while the distal link adjacent to the setup joint and proximal link adjacent to the setup joint remain in the second setup configuration.
 23. The method of claim 22, wherein actuating the actuator to cause rotation of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint comprises rotating a collar rotatably coupled to a link of the plurality of links in a first direction to cause rotation of the distal link adjacent to the setup joint in a corresponding first direction relative to the proximal link adjacent to the setup joint, and rotating the collar in a second direction to cause rotation of the distal link adjacent to the setup joint in a corresponding second direction relative to the proximal link adjacent to the setup joint.
 24. The method of claim 23, wherein actuating the actuator to cause rotation of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint further comprises actuating a setup mode actuator disposed on the collar to permit the rotation of the distal link adjacent to the setup joint in the corresponding first and second directions relative to the proximal link adjacent to the setup joint responsive to rotation of the collar.
 25. The method of claim 22, wherein actuating the actuator to cause rotation of the link distal to the setup joint relative to the link proximal to the setup joint comprises actuating the actuator displayed on a graphical user interface.
 26. The method of claim 25, wherein actuating the actuator displayed on the graphical user interface comprises moving a slidable cursor relative to a neutral center point, and wherein movement of the slidable cursor in a first direction relative to the neutral center point causes rotation of the distal link adjacent to the setup joint in a first direction relative to the proximal link adjacent to the setup joint, and movement of the slidable cursor in a second direction relative to the neutral center point causes rotation of the distal link adjacent to the setup joint in a second direction relative to the proximal link adjacent to the setup joint.
 27. The method of claim 26, further comprising displaying, via the graphical user interface, an indicator indicative of a configuration of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint in real-time responsive to actuation of the actuator.
 28. The method of claim 27, further comprising displaying, via the graphical user interface, graphical representations of a plurality of configurations of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint, such that a position of the indicator relative to the graphical representations of the plurality of configurations is indicative of the configuration of the distal link adjacent to the setup joint relative to the proximal link adjacent to the setup joint in real-time responsive to actuation of the actuator.
 29. The method of claim 22, wherein actuating the actuator to cause rotation of the link distal to the setup joint relative to the link proximal to the setup joint comprises applying, when the actuator is in an actuated state, a force at the distal region of the robot arm in a direction to cause rotation of the distal link adjacent to the setup joint in a corresponding direction relative to the proximal link adjacent to the setup joint.
 30. The method of claim 22, further comprising applying, in a user guided setup mode, a force at the distal region of the robot arm in a direction to cause a stage assembly operatively coupled to the base of the robot arm to move the base of the robot arm in a corresponding direction relative to a platform coupled to the stage assembly. 